Provider Demographics
NPI:1114966017
Name:GURPREET S BAJWA MD PA
Entity Type:Organization
Organization Name:GURPREET S BAJWA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURPREET
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-4015
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-573-4015
Mailing Address - Fax:703-280-1859
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 514
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-573-4015
Practice Address - Fax:703-280-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH57133Medicare UPIN