Basic Information
Provider Information
NPI: 1750814109
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ACHARYA
FirstName: AJITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37189
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212973189
CountryCode: US
TelephoneNumber: 5714235699
FaxNumber: 5714235698
Practice Location
Address1: 1800 N BEAUREGARD ST STE 100
Address2:  
City: ALEXANDRIA
State: VA
PostalCode: 223111726
CountryCode: US
TelephoneNumber: 7039338111
FaxNumber: 7033793965
Other Information
ProviderEnumerationDate: 04/04/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101268197VAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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