Provider Demographics
NPI:1306803663
Name:MARIETA A BAJIT MD
Entity type:Organization
Organization Name:MARIETA A BAJIT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAJIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-853-5280
Mailing Address - Street 1:2876 GUARDIAN LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7327
Mailing Address - Country:US
Mailing Address - Phone:757-463-5240
Mailing Address - Fax:757-463-6572
Practice Address - Street 1:150 KINGSLEY LANE
Practice Address - Street 2:DEPAUL MEDICAL CENTER
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4602
Practice Address - Country:US
Practice Address - Phone:757-889-5000
Practice Address - Fax:757-889-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA263412OtherMDIPA / OPTIMA CHOICE / MAMSI
VA15515OtherSENTARA
VA15515OtherSENTARA
VA051950436Medicare PIN