Provider Demographics
NPI:1023322567
Name:BAWEJA, PRIYANKA (MD)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:BAWEJA
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 1:515 ENTERPRISE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8982
Mailing Address - Country:US
Mailing Address - Phone:479-717-7626
Mailing Address - Fax:479-717-7627
Practice Address - Street 1:515 ENTERPRISE DR STE 300
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8982
Practice Address - Country:US
Practice Address - Phone:479-717-7626
Practice Address - Fax:479-717-7627
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361555452084P0800X
ARE-158632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry