Provider Demographics
NPI:1740262062
Name:AMAR NIJJAR MD MEDICAL CORPO
Entity type:Organization
Organization Name:AMAR NIJJAR MD MEDICAL CORPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-448-1514
Mailing Address - Street 1:PO BOX 12130
Mailing Address - Street 2:3330 MASONIC DR
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2130
Mailing Address - Country:US
Mailing Address - Phone:318-448-1514
Mailing Address - Fax:318-448-1514
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:CHRISTUS ST FRANCES CABRINI HOSPITAL
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71315-2130
Practice Address - Country:US
Practice Address - Phone:318-448-6827
Practice Address - Fax:318-448-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD05510R2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1798819Medicaid