Provider Demographics
NPI:1669556676
Name:BHUSHAN, NEERAJ (MD)
Entity type:Individual
Prefix:
First Name:NEERAJ
Middle Name:
Last Name:BHUSHAN
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 1:1850A TOWN CENTER PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5851
Mailing Address - Country:US
Mailing Address - Phone:703-478-5350
Mailing Address - Fax:703-435-3739
Practice Address - Street 1:1850A TOWN CENTER PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5851
Practice Address - Country:US
Practice Address - Phone:703-478-5350
Practice Address - Fax:703-435-3739
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA246781OtherMAMSI
VA49540OtherANTHEM
VA0001OtherCAREFIRST NCA
VA00006092454Medicaid
VA3933OtherGHMSI
VA541153273OtherTIN
VA0001OtherCAREFIRST NCA
VA110022354Medicare ID - Type UnspecifiedRAILROAD MC
VA541153273OtherTIN
VAB70886Medicare UPIN