Healthcare Provider Details

I. General information

NPI: 1891636742
Provider Name (Legal Business Name): JEEWAN BANIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 15TH ST NW STE 111 NORTON IM CLINIC
NORTON VA
24273-1600
US

IV. Provider business mailing address

96 15TH ST NW STE 111 NORTON IM RESIDENCY CLINIC
NORTON VA
24273-1600
US

V. Phone/Fax

Practice location:
  • Phone: 276-439-1872
  • Fax: 276-439-1872
Mailing address:
  • Phone: 276-439-1872
  • Fax: 276-439-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: