Healthcare Provider Details

I. General information

NPI: 1942839857
Provider Name (Legal Business Name): MANDANA ALIDJANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 MILITARY CUTOFF RD
WILMINGTON NC
28403-5716
US

IV. Provider business mailing address

1642 MILITARY CUTOFF RD
WILMINGTON NC
28403-5716
US

V. Phone/Fax

Practice location:
  • Phone: 910-239-9347
  • Fax: 910-239-9039
Mailing address:
  • Phone: 910-239-9347
  • Fax: 910-239-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number202500178
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: