Provider Demographics
NPI:1164639068
Name:GANJEI, ALI G (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:G
Last Name:GANJEI
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 1:2501 PARKERS LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22334-0001
Mailing Address - Country:US
Mailing Address - Phone:410-793-0791
Mailing Address - Fax:410-793-0809
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22334-0001
Practice Address - Country:US
Practice Address - Phone:410-793-0791
Practice Address - Fax:410-793-0809
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010453952081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6835775Medicaid
VA6835775Medicaid