MEDICARE: DR. MJ HAJIANPOUR M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	53464	TN
2	207SC0300X	Clinical Cytogenetics Physician	53464	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	37614470	OTHER	TN	TN GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A48350	OTHER	CA	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1336248996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MJ HAJIANPOUR M.D., PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 699
Second Line	:
City	:	MOUNTAIN HOME
State	:	TN
Zip	:	37684-0699
Country	:	US
Telephone Number	:	423-433-6039
Fax Number	:	423-433-6060

Provider Business Practice Location Address
First Line	:	22 NEW SCOTLAND AVE DEPT OF
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3795
Country	:	US
Telephone Number	:	518-262-5120
Fax Number	:	518-262-5924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/19/2022

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