Basic Information
Provider Information
NPI: 1407017957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAJAJ
FirstName: NEERAJ
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7236 STONEROCK CIR
Address2:  
City: ORLANDO
State: FL
PostalCode: 328198000
CountryCode: US
TelephoneNumber: 3218416444
FaxNumber: 4076501307
Practice Location
Address1: 7236 STONEROCK CIR
Address2:  
City: ORLANDO
State: FL
PostalCode: 328198000
CountryCode: US
TelephoneNumber: 3218416444
FaxNumber: 4076501307
Other Information
ProviderEnumerationDate: 06/18/2008
LastUpdateDate: 05/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XME108724FLN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207UN0901XME108724FLN Allopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
207RI0011XME108724FLY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
00323210005FL MEDICAID


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