Provider Demographics
NPI:1811954142
Name:TAJA, ABDULLA (MD)
Entity type:Individual
Prefix:
First Name:ABDULLA
Middle Name:
Last Name:TAJA
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 1:375 N EASTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2214
Mailing Address - Country:US
Mailing Address - Phone:419-228-3500
Mailing Address - Fax:419-228-6700
Practice Address - Street 1:375 N EASTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2214
Practice Address - Country:US
Practice Address - Phone:419-228-3500
Practice Address - Fax:419-228-6700
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084655207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000340019OtherANTHEM
OH3603418OtherAETNA
OH2488197Medicaid
OH2488197Medicaid
OH3603418OtherAETNA