Basic Information
Provider Information
NPI: 1457903254
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAHJWANI
FirstName: DHWANI
MiddleName: SANJAY
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3300 GALLOWS RD
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220423307
CountryCode: US
TelephoneNumber: 7037766652
FaxNumber:  
Practice Location
Address1: 3300 GALLOWS RD
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220423307
CountryCode: US
TelephoneNumber: 7037766652
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2019
LastUpdateDate: 09/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X0116032464VAN Student, Health CareStudent in an Organized Health Care Education/Training Program 
208000000X0116032464VAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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