Basic Information
| Provider Information | |||||||||
| NPI: | 1174660633 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BANAJI | ||||||||
| FirstName: | MRIDULA | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 EAST JEFFERSON STREET | ||||||||
| Address2: | KAISER PERMANENTE, PPQA, 6 WEST, | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018166660 | ||||||||
| FaxNumber: | 3018166308 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NORTH WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035361500 | ||||||||
| FaxNumber: | 7035361395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0059466 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD33954 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | 0101233266 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.