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General NPI Number Information
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NPI Number | 1245301779
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Entity Type | Individual
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Provider Name | FADIL AJAJ YUNIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 203 CENTENNIAL ST. STE. 104
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City | LA PLATA
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State | MD
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Zip | 20646-2540
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Country | US
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Telephone | 301-934-2776
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Fax | 301-934-1417
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Provider Business Mailing Address
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Address Line | PO BOX 2540
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City | LA PLATA
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State | MD
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Zip | 20646-2540
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Country | US
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Telephone | 301-934-2776
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Fax | 301-934-1417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D0042716
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License Number State | MD
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