Provider Demographics
NPI:1447221460
Name:JALLER, DAVID ELIJAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELIJAH
Last Name:JALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4805 TALLAHASSEE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3144
Mailing Address - Country:US
Mailing Address - Phone:301-942-9773
Mailing Address - Fax:888-909-4910
Practice Address - Street 1:184 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-624-5544
Practice Address - Fax:301-624-4164
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD244P520GMedicare PIN
MDC34730Medicare UPIN