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

Table of content: ALYSSA HOLMES (NPI 1922685650)

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".




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