Provider Demographics
NPI:1336248996
Name:HAJIANPOUR, MJ (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MJ
Middle Name:
Last Name:HAJIANPOUR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MOHAMAD JAVAD
Other - Middle Name:
Other - Last Name:HAJIANPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6039
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:22 NEW SCOTLAND AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3795
Practice Address - Country:US
Practice Address - Phone:518-262-5120
Practice Address - Fax:518-262-5924
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53464207SG0201X, 207SC0300X
IA41164207SC0300X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A483500Medicaid
TN37614470OtherTN GROUP MEDICARE
CAA48350OtherMEDICAL LICENSE NUMBER
CAA48350OtherMEDICAL LICENSE NUMBER