1063496628 NPI number — DR. JERJIS T ALAJAJI MD

Table of content: DR. JERJIS T ALAJAJI MD (NPI 1063496628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063496628 NPI number — DR. JERJIS T ALAJAJI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAJAJI
Provider First Name:
JERJIS
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALAJAJI
Provider Other First Name:
GEORGE
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063496628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10373A REISTERSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-548-7595
Provider Business Mailing Address Fax Number:
443-436-1256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8820 COLUMBIA 100 PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-298-0454
Provider Business Practice Location Address Fax Number:
443-663-6883
Provider Enumeration Date:
12/06/2005

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: 2085R0202X , with the licence number:  D0037407 , 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: 628005600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 768852824A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063496628 . This is a "BS INDVIDUAL ID NBR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11503726 . This is a "CAQH PROVIDER NBR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00414989 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 9177139 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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