Provider Demographics
NPI:1902819196
Name:AMJADI, AMIRALI (MD)
Entity Type:Individual
Prefix:
First Name:AMIRALI
Middle Name:
Last Name:AMJADI
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:PO BOX 61363
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-1363
Mailing Address - Country:US
Mailing Address - Phone:301-345-1272
Mailing Address - Fax:301-474-2671
Practice Address - Street 1:7721 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3300
Practice Address - Country:US
Practice Address - Phone:301-345-1272
Practice Address - Fax:301-474-2671
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059993207RI0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN1510005OtherBLUE CROSS FEDERAL
MD000341700Medicaid
MD01293247OtherAMERIGROUP
DC035160700Medicaid
MD4130464OtherUNITED HEALTHCARE
MD7075795OtherCIGNA
MD62115604OtherBLUE CROSS OF MARYLAND
MD7937465OtherAETNA
MDP00779344OtherRAILROAD
MDN1510005OtherBLUE CROSS FEDERAL
MD4130464OtherUNITED HEALTHCARE