Provider Demographics
NPI:1184612178
Name:HEGDE, DINRAJ (MD)
Entity type:Individual
Prefix:
First Name:DINRAJ
Middle Name:
Last Name:HEGDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 ROSEHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2840
Mailing Address - Country:US
Mailing Address - Phone:703-938-0363
Mailing Address - Fax:703-938-8653
Practice Address - Street 1:10530 ROSEHAVEN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2840
Practice Address - Country:US
Practice Address - Phone:703-938-0363
Practice Address - Fax:703-938-8653
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112944207Q00000X
TXN2112207Q00000X
VA0101267175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112944Medicaid
IL256510009Medicare PIN