Provider Demographics
NPI:1629334859
Name:BAVISHI, SEJAL (MD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:BAVISHI
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 1:145 CENTURY DR APT 5404
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 WISCONSIN AVE NW
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:201-407-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics