Individual provider Active NPI

Samina S. Raja, MD

  • Psychiatry Physician
  • Fairfax, VA
National Provider Identifier
1023336575
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2014-01263 Issued in NC
Practice address
3993 Alcoa Dr
Fairfax, VA 22033-1402
Phone
(703) 579-7667
NPI assigned
May 7, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 2014-01263 NC Primary

Addresses

Primary practice location

3993 Alcoa Dr
Fairfax, VA 22033-1402

Mailing address

3993 Alcoa Dr
Fairfax, VA 22033-1402
Phone (703) 579-7667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231017003920 DC Practitioner - Psychiatry 8921301748 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2014-01263NCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neuropsych Wellness Center, PC Psychiatry CurrentSince Sep 5, 2023 Accepting new patients

Locations

3930 Pender Dr
Ste 240
Fairfax, VA 22030
Phone (703) 865-8686

3930 Pender Dr
Ste 350
Fairfax, VA 22030
Phone (703) 865-6565

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1023336575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3993 ALCOA DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331402",
            "telephone_number": "703-579-7667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3993 ALCOA DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331402",
            "telephone_number": "703-579-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJA",
        "first_name": "SAMINA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-07",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2014-01263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.