Provider Demographics
NPI:1205856515
Name:MAHARAJ, BARRY R (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:MAHARAJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19441 GOLF VISTA PLZ
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8269
Mailing Address - Country:US
Mailing Address - Phone:703-723-7858
Mailing Address - Fax:703-723-7882
Practice Address - Street 1:19441 GOLF VISTA PLZ
Practice Address - Street 2:SUITE 130
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8269
Practice Address - Country:US
Practice Address - Phone:703-723-7858
Practice Address - Fax:703-723-7882
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380001271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
292375OtherMAMSI/ALLIANCE
384338OtherANTHEM BCBS
VA008000531Medicaid