Provider Demographics
NPI:1508840380
Name:NAMJOSHI, KAVITA SHANTANU (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:SHANTANU
Last Name:NAMJOSHI
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 1:21882 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6911
Mailing Address - Country:US
Mailing Address - Phone:775-848-8287
Mailing Address - Fax:703-997-2627
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:STE 260
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5899
Practice Address - Country:US
Practice Address - Phone:775-123-1234
Practice Address - Fax:703-997-2627
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045994207R00000X
CT047932207R00000X, 208M00000X
VA0101245322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016761Medicaid
NV002016761Medicaid
NV100346Medicare ID - Type Unspecified