Provider Demographics
NPI:1366152357
Name:BAJWA, GURPREET K
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:K
Last Name:BAJWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26613 MARBURY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6420
Mailing Address - Country:US
Mailing Address - Phone:703-200-1015
Mailing Address - Fax:
Practice Address - Street 1:26613 MARBURY ESTATES DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-6420
Practice Address - Country:US
Practice Address - Phone:703-200-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty