Basic Information
| Provider Information | |||||||||
| NPI: | 1891759841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAJIT | ||||||||
| FirstName: | MARIETA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | 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: | 233054602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895000 | ||||||||
| FaxNumber: | 7578894850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101023495 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 115369 | 01 | VA | ANTHEM | OTHER | 5720044 | 05 | VA | MEDICAID | 15515 | 01 | VA | SENTARA OPTIMA | OTHER | 890504B | 05 | NC | MEDICAID | 263412 | 01 | VA | MPIPA OPTIMA CHOICE MAMSI | OTHER |