1245301779 NPI number — DR. FADIL AJAJ YUNIS M.D.

Table of content: DR. FADIL AJAJ YUNIS M.D. (NPI 1245301779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245301779 NPI number — DR. FADIL AJAJ YUNIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YUNIS
Provider First Name:
FADIL
Provider Middle Name:
AJAJ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1245301779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-2540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-934-2776
Provider Business Mailing Address Fax Number:
301-934-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 CENTENNIAL ST.
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-934-2776
Provider Business Practice Location Address Fax Number:
301-934-1417
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  D0042716 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BLUE HOICE . This is a "3162-0001" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3162 0001 . This is a "CAREFIRST BCBS FED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "ALLIANCE PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2431743 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4046524002 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 545605-04 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522271634004 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "GEHA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146649 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 811046800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147954200 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com