Healthcare Provider Details

I. General information

NPI: 1962755827
Provider Name (Legal Business Name): JAWAD M BAJWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

IV. Provider business mailing address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-9878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME127778
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101262079
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: