Provider Demographics
NPI:1205860533
Name:GAJJAR, TUSHAR UMAKANT (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:UMAKANT
Last Name:GAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 2700
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-221-0110
Practice Address - Fax:757-221-0851
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-840455207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG43323Medicare UPIN
VAG43323Medicare UPIN
VA278156OtherANTHEM BCBS
VA00V344V84Medicare ID - Type Unspecified
VA5720958Medicaid
63795OtherSENTARA