Healthcare Provider Details

I. General information

NPI: 1942299458
Provider Name (Legal Business Name): ALPA L. JANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/14/2020
Certification Date: 03/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 WESTVIEW DR STE 102
FREDERICK MD
21703-8372
US

IV. Provider business mailing address

5300 WESTVIEW DR STE 102
FREDERICK MD
21703-8372
US

V. Phone/Fax

Practice location:
  • Phone: 240-831-4743
  • Fax: 240-831-4539
Mailing address:
  • Phone: 240-831-4743
  • Fax: 240-831-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD0061753
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: