Provider Demographics
NPI:1326011958
Name:BERENJI, KAMBEEZ (MD)
Entity Type:Individual
Prefix:
First Name:KAMBEEZ
Middle Name:
Last Name:BERENJI
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 1:2022 OPITZ BLVD STE A&B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3323
Mailing Address - Country:US
Mailing Address - Phone:571-398-2341
Mailing Address - Fax:571-398-6388
Practice Address - Street 1:2022 OPITZ BLVD STE A&B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3323
Practice Address - Country:US
Practice Address - Phone:571-398-2341
Practice Address - Fax:571-398-6388
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242617207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00773OtherPTAN
VAC06380OtherMEDICARE OF VA PTAN
INI44955Medicare UPIN
IN898190J5Medicare ID - Type Unspecified