Provider Demographics
NPI:1518146554
Name:AGGARWAL, RAJIV KUMAR (MBBS)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:KUMAR
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:STE 340
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5912
Mailing Address - Country:US
Mailing Address - Phone:571-223-3833
Mailing Address - Fax:
Practice Address - Street 1:211 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2905
Practice Address - Country:US
Practice Address - Phone:571-223-3833
Practice Address - Fax:571-223-3834
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103878Medicaid
VA010103878Medicaid
DCG01880L01Medicare PIN
VA00W092L01Medicare PIN