Provider Demographics
NPI:1780677989
Name:DHILLON, BALRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:BALRAJ
Middle Name:
Last Name:DHILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-369-8464
Mailing Address - Fax:703-369-8467
Practice Address - Street 1:8680 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4287
Practice Address - Country:US
Practice Address - Phone:703-369-8464
Practice Address - Fax:703-369-8467
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012366022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780677989Medicaid
DCG02169N01Medicare PIN
VA005623P82Medicare PIN
VA1780677989Medicaid