Provider Demographics
NPI:1225226210
Name:RIAZ A. JANJUA, M.D.
Entity Type:Organization
Organization Name:RIAZ A. JANJUA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JANJUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-777-1930
Mailing Address - Street 1:625 KENT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-777-1930
Mailing Address - Fax:301-777-8470
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-777-1930
Practice Address - Fax:301-777-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002584Medicaid