Provider Demographics
NPI: | 1114935772 |
---|---|
Name: | SAINI, KANWARPREET (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KANWARPREET |
Middle Name: | |
Last Name: | SAINI |
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: | 2025 GLENN MITCHELL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | VIRGINIA BCH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23456-0178 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-507-4123 |
Mailing Address - Fax: | 757-261-5849 |
Practice Address - Street 1: | 2025 GLENN MITCHELL DR |
Practice Address - Street 2: | |
Practice Address - City: | VIRGINIA BCH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23456-0178 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-507-4123 |
Practice Address - Fax: | 757-261-5849 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-03 |
Last Update Date: | 2019-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101236994 | 207R00000X, 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 010097681 | Medicaid | |
VA | 78583 | Other | SENTARA |
VA | 010097681 | Medicaid | |
VA | 005615C05 | Medicare PIN |