Provider Demographics
NPI:1396786141
Name:NORTHERN VIRGINIA PSYCHIATRIC GROUP
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PSYCHIATRIC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJPAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-698-5220
Mailing Address - Street 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2225
Mailing Address - Country:US
Mailing Address - Phone:703-698-5220
Mailing Address - Fax:703-573-2351
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-698-5220
Practice Address - Fax:703-573-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403204700Medicaid
DC1547OtherCAREFIRST BC/BS
4507888OtherAETNA
DC898156Medicare PIN
DC1547OtherCAREFIRST BC/BS