Healthcare Provider Details

I. General information

NPI: 1003931767
Provider Name (Legal Business Name): NIRAJ GOVIL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 CAMERON RUN TER APT 1115
ALEXANDRIA VA
22303-1811
US

IV. Provider business mailing address

1060 W PERIMETER RD STE 3K43
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 240-612-1076
  • Fax:
Mailing address:
  • Phone: 937-938-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMA66454
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: