Provider Demographics
NPI:1861486672
Name:BAJWA, GURPREET S (MD PA)
Entity Type:Individual
Prefix:DR
First Name:GURPREET
Middle Name:S
Last Name:BAJWA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2810 OLD LEE HWY
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4376
Mailing Address - Country:US
Mailing Address - Phone:703-573-4015
Mailing Address - Fax:703-280-1859
Practice Address - Street 1:2810 OLD LEE HWY
Practice Address - Street 2:SUITE 200B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4376
Practice Address - Country:US
Practice Address - Phone:703-573-4015
Practice Address - Fax:703-280-1859
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101231157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA201501977OtherFEDERAL TAX ID NUMBER
VAH57133Medicare UPIN