Provider Demographics
NPI:1083746325
Name:BANIAN, BARKEV H (MD)
Entity Type:Individual
Prefix:DR
First Name:BARKEV
Middle Name:H
Last Name:BANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14904 JEFFERSEON DAVIS HWY, SUITE 412
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-491-3100
Mailing Address - Fax:703-491-3842
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 412
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-491-3100
Practice Address - Fax:703-491-3842
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029904207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC36554Medicare UPIN