Healthcare Provider Details

I. General information

NPI: 1063619658
Provider Name (Legal Business Name): MOHIT JINDAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4500
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4021
  • Fax: 804-272-6895
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01069482A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD440196
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101263487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: