Healthcare Provider Details

I. General information

NPI: 1063496628
Provider Name (Legal Business Name): JERJIS T ALAJAJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE T ALAJAJI MD

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 COLUMBIA 100 PKWY STE 100
COLUMBIA MD
21045-2169
US

IV. Provider business mailing address

10373A REISTERSTOWN RD
OWINGS MILLS MD
21117-3617
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-0454
  • Fax: 443-663-6883
Mailing address:
  • Phone: 443-548-7595
  • Fax: 443-436-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0037407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: