Provider Demographics
NPI:1588615082
Name:MAJID, ANEESA S (MD)
Entity Type:Individual
Prefix:
First Name:ANEESA
Middle Name:S
Last Name:MAJID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E HURON ST APT 2005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3873
Mailing Address - Country:US
Mailing Address - Phone:210-617-0555
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL70252085R0202X
IN01092053A2085R0202X
NY2469402085R0204X
IL0361071952085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162464505Medicaid
TX162464506OtherCSHCN
TX8AL152OtherBCBS
TX8AL152OtherBCBS
TXH79928Medicare UPIN
TX8J7397Medicare PIN