Provider Demographics
NPI:1063150191
Name:JAILANI, MOHAMED AYAZ AHMED G (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED AYAZ AHMED G
Middle Name:
Last Name:JAILANI
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:VETERANS ADMINISTRATION
Mailing Address - Street 2:555 WILLARD AVENUE
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-808-7921
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:VETERANS ADMINISTRATION
Practice Address - Street 2:555 WILLARD AVENUE
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-808-7921
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program