1902819196 NPI number — AMIRALI AMJADI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902819196 NPI number — AMIRALI AMJADI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

AMJADI

Provider First Name:

AMIRALI

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1902819196

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 61363

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

POTOMAC

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20859-1363

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-345-1272

Provider Business Mailing Address Fax Number:

301-474-2671

Provider First Line Business Practice Location Address:

7721 BELLE POINT DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GREENBELT

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20770-3300

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-345-1272

Provider Business Practice Location Address Fax Number:

301-474-2671

Provider Enumeration Date:

08/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RI0200X , with the licence number:  D0059993 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 174400000X , with the licence number: D0059993 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: N1510005 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 000341700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 01293247 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 035160700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
• Identifier: 4130464 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7075795 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 62115604 . This is a "BLUE CROSS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7937465 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: P00779344 . This is a "RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".