Provider Demographics
NPI:1770745770
Name:DAJANI, KHALED AHMAD (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:AHMAD
Last Name:DAJANI
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2080 W ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3770
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-689-6502
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206499207LP3000X
PAMD475218207L00000X
IL036152577207LP3000X
390200000X
VA0101269525207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2343629Medicaid
MS02157721Medicaid
LA2343629Medicaid