Provider Demographics
NPI:1508865908
Name:JANJUA, RIAZ A (MD)
Entity type:Individual
Prefix:DR
First Name:RIAZ
Middle Name:A
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 1:625 KENT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-777-1930
Mailing Address - Fax:301-777-8470
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-777-1930
Practice Address - Fax:301-777-8470
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-01-26
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
MDD00220292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD982161900Medicaid
MDD76357Medicare UPIN
MD153742ZDV0Medicare PIN