=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063496628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JERJIS T ALAJAJI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 11/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8820 COLUMBIA 100 PKWY STE 100
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-298-0454
-----------------------------------------------------
Fax | 443-663-6883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10373A REISTERSTOWN RD
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-548-7595
-----------------------------------------------------
Fax | 443-436-1256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | D0037407
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------