=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962755827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAWAD M BAJWA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2012
-----------------------------------------------------
Last Update Date | 05/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 ILIFF DR
-----------------------------------------------------
City | DUNN LORING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22027-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-9878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 ILIFF DR
-----------------------------------------------------
City | DUNN LORING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22027-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | ME127778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 0101262079
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------