Basic Information
Provider Information
NPI: 1326048661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AJLOUNY
FirstName: MARTHA
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1036 BRANCHVIEW DR STE 100
Address2:  
City: CONCORD
State: NC
PostalCode: 280250112
CountryCode: US
TelephoneNumber: 7048861918
FaxNumber: 7048861918
Practice Location
Address1: 530 N ELAM AVE
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274031153
CountryCode: US
TelephoneNumber: 3362990271
FaxNumber: 3362998117
Other Information
ProviderEnumerationDate: 07/28/2005
LastUpdateDate: 02/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X425NCN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0131X425NCN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
213EP1101X425NCY Podiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine

No ID Information.


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