Provider Demographics
NPI:1760869754
Name:BAJAJ, BALRAJ S (MD)
Entity Type:Individual
Prefix:
First Name:BALRAJ
Middle Name:S
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:7605 FOREST AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4936
Practice Address - Country:US
Practice Address - Phone:804-285-4025
Practice Address - Fax:804-288-2659
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101267271207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAC617AOtherMEDICARE PTAN
VA1760869754Medicaid