Provider Demographics
NPI:1033309562
Name:BAJINA, SHAM RUSTOM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAM
Middle Name:RUSTOM
Last Name:BAJINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:701 W RED BANK AVENUE
Mailing Address - Street 2:APT K16
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4940
Mailing Address - Country:US
Mailing Address - Phone:856-848-2165
Mailing Address - Fax:
Practice Address - Street 1:765 ROUTE 70 EAST
Practice Address - Street 2:CFG HEALTH SYSTEMS LLC BLDG A SUITE 101
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-3900
Practice Address - Fax:856-810-0169
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02829400207Q00000X
PAMD034586L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4586000Medicaid
NJ4586000Medicaid
BA004760Medicare PIN