Provider Demographics
NPI:1679681902
Name:MANEJWALA, ALIF (MD)
Entity Type:Individual
Prefix:
First Name:ALIF
Middle Name:
Last Name:MANEJWALA
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 1:1307 CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4024
Mailing Address - Country:US
Mailing Address - Phone:410-761-0500
Mailing Address - Fax:410-787-0857
Practice Address - Street 1:1307 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4024
Practice Address - Country:US
Practice Address - Phone:410-761-0500
Practice Address - Fax:410-787-0857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29748207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD275781800Medicaid
C49259Medicare UPIN
MD275781800Medicaid