Provider Demographics
NPI:1265679286
Name:MAHAJAN, AMIT KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:KUMAR
Last Name:MAHAJAN
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 1:2921 TELESTAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1205
Mailing Address - Country:US
Mailing Address - Phone:703-280-5858
Mailing Address - Fax:703-849-0874
Practice Address - Street 1:2921 TELESTAR CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1205
Practice Address - Country:US
Practice Address - Phone:703-280-5858
Practice Address - Fax:703-849-0874
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051798207R00000X
VA0101256907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine