Provider Demographics
NPI:1265401236
Name:RAJAEE, HALEH (MD)
Entity type:Individual
Prefix:
First Name:HALEH
Middle Name:
Last Name:RAJAEE
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 1:422 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1573
Mailing Address - Country:US
Mailing Address - Phone:540-720-2126
Mailing Address - Fax:540-720-1002
Practice Address - Street 1:422 GARRISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1573
Practice Address - Country:US
Practice Address - Phone:540-720-2126
Practice Address - Fax:540-720-1002
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6736009Medicaid
VA6736009Medicaid