Provider Demographics
NPI:1992873400
Name:MEHRA, RAJESH N (DO)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:N
Last Name:MEHRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 BROOKFIELD CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2122
Mailing Address - Country:US
Mailing Address - Phone:703-968-7277
Mailing Address - Fax:703-968-5644
Practice Address - Street 1:4437 BROOKFIELD CORPORATE DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2122
Practice Address - Country:US
Practice Address - Phone:703-968-7277
Practice Address - Fax:703-968-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102033582261QP2300X
VAVA0102033582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD18017Medicare UPIN