Provider Demographics
NPI:1063496628
Name:ALAJAJI, JERJIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:JERJIS
Middle Name:T
Last Name:ALAJAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:T
Other - Last Name:ALAJAJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10373A REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3617
Mailing Address - Country:US
Mailing Address - Phone:443-548-7595
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:8820 COLUMBIA 100 PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2169
Practice Address - Country:US
Practice Address - Phone:410-298-0454
Practice Address - Fax:443-663-6883
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00374072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD628005600Medicaid
GA768852824AMedicaid
GA1063496628OtherBS INDVIDUAL ID NBR
GA11503726OtherCAQH PROVIDER NBR
GAP00414989OtherRR MEDICARE PIN
GA9177139OtherCIGNA
G21980Medicare UPIN