Basic Information
| Provider Information | |||||||||
| NPI: | 1063496628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALAJAJI | ||||||||
| FirstName: | JERJIS | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALAJAJI | ||||||||
| OtherFirstName: | GEORGE | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10373A REISTERSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211173617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435487595 | ||||||||
| FaxNumber: | 4434361256 | ||||||||
| Practice Location | |||||||||
| Address1: | 8820 COLUMBIA 100 PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210452169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102980454 | ||||||||
| FaxNumber: | 4436636883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D0037407 | MD | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 628005600 | 05 | MD | MEDICAID | 768852824A | 05 | GA | MEDICAID | 1063496628 | 01 | GA | BS INDVIDUAL ID NBR | OTHER | 11503726 | 01 | GA | CAQH PROVIDER NBR | OTHER | P00414989 | 01 | GA | RR MEDICARE PIN | OTHER | 9177139 | 01 | GA | CIGNA | OTHER |