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General NPI Number Information
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NPI Number | 1629334859
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Entity Type | Individual
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Provider Name | SEJAL BAVISHI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 4200 WISCONSIN AVE NW DEPARTMENT OF PEDIATRICS
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City | WASHINGTON
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State | DC
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Zip | 20016-2143
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Country | US
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Telephone | 201-407-3935
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Fax |
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Provider Business Mailing Address
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Address Line | 145 CENTURY DR APT 5404
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City | ALEXANDRIA
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State | VA
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Zip | 22304-5791
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD043202
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License Number State | DC
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