Basic Information
| Provider Information | |||||||||
| NPI: | 1114935772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAINI | ||||||||
| FirstName: | KANWARPREET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 GLENN MITCHELL DR | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575074123 | ||||||||
| FaxNumber: | 7572615849 | ||||||||
| Practice Location | |||||||||
| Address1: | 2025 GLENN MITCHELL DR | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575074123 | ||||||||
| FaxNumber: | 7572615849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101236994 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101236994 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 010097681 | 05 | VA | MEDICAID | 78583 | 01 | VA | SENTARA | OTHER |