Provider Demographics
NPI:1558402651
Name:AULAKH, PAVITAR P (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVITAR
Middle Name:P
Last Name:AULAKH
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 1:8633 OAK CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3331
Mailing Address - Country:US
Mailing Address - Phone:703-994-6171
Mailing Address - Fax:703-805-0967
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:DEWITT ARMY COMMUNITY HOSPITAL, BLDG 815
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0110
Practice Address - Fax:703-805-0967
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010520672084P0800X
MDD570852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23701Medicare UPIN
011217M92Medicare ID - Type Unspecified