Provider Demographics
NPI:1972774735
Name:KHAITAN, PUJA GAUR (MD)
Entity type:Individual
Prefix:DR
First Name:PUJA
Middle Name:GAUR
Last Name:KHAITAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING STREET NW
Mailing Address - Street 2:SUITE G253
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-877-8115
Mailing Address - Fax:202-877-3699
Practice Address - Street 1:110 IRVING ST NW STE G253
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-8115
Practice Address - Fax:202-877-3699
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8663208G00000X
DCMD045240208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8ED510OtherBCBS
TX8DV847OtherBCBS
TX325187802Medicaid
TX318041ZSWDMedicare PIN
TX8DV847OtherBCBS