Healthcare Provider Details

I. General information

NPI: 1750371019
Provider Name (Legal Business Name): RAJIV BAVEJA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PROSPERITY AVE STE B
FAIRFAX VA
22031-4324
US

IV. Provider business mailing address

2730 PROSPERITY AVE STE B
FAIRFAX VA
22031-4324
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-1400
  • Fax: 703-789-1414
Mailing address:
  • Phone: 703-289-1400
  • Fax: 703-789-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101241672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: