Basic Information
| Provider Information | |||||||||
| NPI: | 1306803663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIETA A BAJIT MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2876 GUARDIAN LANE | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234527327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574635240 | ||||||||
| FaxNumber: | 7574636572 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 KINGSLEY LANE | ||||||||
| Address2: | DEPAUL MEDICAL CENTER | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895000 | ||||||||
| FaxNumber: | 7578894850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BAJIT | ||||||||
| AuthorizedOfficialFirstName: | MARIETA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7578535280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 263412 | 01 | VA | MDIPA / OPTIMA CHOICE / MAMSI | OTHER | 15515 | 01 | VA | SENTARA | OTHER |