MEDICARE: DR. GURPREET S BAJWA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101231157	VA

General Provider Information

NPI Number	:	1861486672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GURPREET S BAJWA MD PA

Provider Business Mailing Address
First Line	:	2810 OLD LEE HWY
Second Line	:	SUITE 200B
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4376
Country	:	US
Telephone Number	:	703-573-4015
Fax Number	:	703-280-1859

Provider Business Practice Location Address
First Line	:	2810 OLD LEE HWY
Second Line	:	SUITE 200B
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4376
Country	:	US
Telephone Number	:	703-573-4015
Fax Number	:	703-280-1859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	06/26/2012

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