MEDICARE: DR. MOHAMMAD ALJANABY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	042179	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11528277	OTHER	CT	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003857707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD ALJANABY M.D.

Provider Business Mailing Address
First Line	:	74 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1853
Country	:	US
Telephone Number	:	860-218-1725
Fax Number	:	860-218-1727

Provider Business Practice Location Address
First Line	:	74 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1853
Country	:	US
Telephone Number	:	860-218-1725
Fax Number	:	860-218-1727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	05/24/2012

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