Provider Demographics
NPI:1093945727
Name:BAJPAI, SIDDHARTH (MD)
Entity type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:
Last Name:BAJPAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2228
Mailing Address - Country:US
Mailing Address - Phone:319-356-1616
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2228
Practice Address - Country:US
Practice Address - Phone:319-356-1616
Practice Address - Fax:703-573-2351
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-85372084P0800X
VA01012602382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3480527ZC6LMedicare PIN