Provider Demographics
NPI:1376534172
Name:GAJJAR-SIVA, NEHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:
Last Name:GAJJAR-SIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 CONNECTICUT AVE NW
Mailing Address - Street 2:#807
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1536
Mailing Address - Country:US
Mailing Address - Phone:202-422-3688
Mailing Address - Fax:
Practice Address - Street 1:2828 CONNECTICUT AVE NW
Practice Address - Street 2:#807
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1536
Practice Address - Country:US
Practice Address - Phone:202-422-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235298207R00000X, 208000000X
MDD0071755208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010155291Medicaid
VA004480V16Medicare ID - Type Unspecified
VA010155291Medicaid