Provider Demographics
NPI:1831137264
Name:BAJAJ, ANITA M (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:BAJAJ
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 1:4 NESHAMINY INTERPLEX
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6940
Mailing Address - Country:US
Mailing Address - Phone:215-244-3070
Mailing Address - Fax:215-638-9041
Practice Address - Street 1:3998 RED LION ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA446722085R0202X
PAMD4361192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446720Medicaid
CA00A446720OtherBLUE SHIELD
PA102248295-0001Medicaid
CAGR0106037Medicaid
CAWA44672DMedicare PIN
PA148978D2YMedicare PIN
CAWA44672GMedicare PIN
CA00A446720OtherBLUE SHIELD
CAWA44672FMedicare PIN
CAG23803Medicare UPIN
CAWA44672CMedicare PIN
CAWA44672BMedicare PIN
CA00A446720Medicaid
CAWA44672EMedicare PIN