Provider Demographics
NPI:1194939033
Name:PURI, RAJESH (MD, FAAP, FACPH)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:PURI
Suffix:
Gender:M
Credentials:MD, FAAP, FACPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 N BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2526
Mailing Address - Country:US
Mailing Address - Phone:703-688-2468
Mailing Address - Fax:703-859-7689
Practice Address - Street 1:2221 N BUCHANAN ST
Practice Address - Street 2:SUITE B.
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-2526
Practice Address - Country:US
Practice Address - Phone:703-688-2468
Practice Address - Fax:703-688-2608
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047343208000000X, 202K00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology