Provider Demographics
NPI:1730106493
Name:WADHWA, JAGDISH (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:
Last Name:WADHWA
Suffix:
Gender:M
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:PO BOX 4359
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-8461
Mailing Address - Country:US
Mailing Address - Phone:703-724-4000
Mailing Address - Fax:703-724-4017
Practice Address - Street 1:20925 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-724-4000
Practice Address - Fax:703-724-4017
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79003Medicare UPIN