Provider Demographics
NPI:1578553897
Name:VANGIESON, AJIJA B (MD)
Entity Type:Individual
Prefix:
First Name:AJIJA
Middle Name:B
Last Name:VANGIESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8820 COPENHAVER DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3007
Mailing Address - Country:US
Mailing Address - Phone:202-635-5785
Mailing Address - Fax:202-636-5789
Practice Address - Street 1:1731 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3026
Practice Address - Country:US
Practice Address - Phone:202-635-5785
Practice Address - Fax:202-636-5789
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics