Basic Information
| Provider Information | |||||||||
| NPI: | 1376830182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AJEBON | ||||||||
| FirstName: | ZOE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SOLAREX CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217038624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016636162 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3430 WORTHINGTON BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217047017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402156900 | ||||||||
| FaxNumber: | 2404366300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0116024070 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | H077754 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 926580509 | 05 | MD | MEDICAID | 926580505 | 05 | MD | MEDICAID |