MEDICARE: ADNAN TAJ-ELDIN MD

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	207R00000X	Internal Medicine Physician	21725	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	561632684	OTHER	TRICARE
2	81418	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770501678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADNAN TAJ-ELDIN MD

Provider Business Mailing Address
First Line	:	200 DOCTORS DR
Second Line	:	SUITE I
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6308
Country	:	US
Telephone Number	:	910-353-6327
Fax Number	:	910-353-6329

Provider Business Practice Location Address
First Line	:	200 DOCTORS DR
Second Line	:	SUITE I
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6308
Country	:	US
Telephone Number	:	910-353-6327
Fax Number	:	910-353-6329

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/30/2009

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