Provider Demographics
NPI:1003857707
Name:ALJANABY, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:ALJANABY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1853
Mailing Address - Country:US
Mailing Address - Phone:860-218-1725
Mailing Address - Fax:860-218-1727
Practice Address - Street 1:74 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1853
Practice Address - Country:US
Practice Address - Phone:860-218-1725
Practice Address - Fax:860-218-1727
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042179208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11528277OtherCAQH
CT001421792Medicaid
CT11528277OtherCAQH