Provider Demographics
NPI:1770501678
Name:TAJ-ELDIN, ADNAN (MD)
Entity Type:Individual
Prefix:
First Name:ADNAN
Middle Name:
Last Name:TAJ-ELDIN
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 1:200 DOCTORS DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-6327
Mailing Address - Fax:910-353-6329
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:SUITE I
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-6327
Practice Address - Fax:910-353-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
561632684OtherTRICARE
81418OtherBCBS
NC8981418Medicaid
201869Medicare ID - Type Unspecified
NC8981418Medicaid