Provider Demographics
NPI:1912162728
Name:JANJUA, AHMED J (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:J
Last Name:JANJUA
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 1:5300 HARROUN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2182
Mailing Address - Country:US
Mailing Address - Phone:419-824-6350
Mailing Address - Fax:419-882-3847
Practice Address - Street 1:5300 HARROUN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2182
Practice Address - Country:US
Practice Address - Phone:419-824-6350
Practice Address - Fax:419-882-3847
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0947332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050023Medicaid
OH9611679OtherAETNA
OH000000718143OtherANTHEM
OHP00988220OtherRRMC
OH07132OtherPARAMOUNT
OH0050023Medicaid