Provider Demographics
NPI:1306811948
Name:MUJAHID, ANJUM (MD)
Entity type:Individual
Prefix:DR
First Name:ANJUM
Middle Name:
Last Name:MUJAHID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANJUM
Other - Middle Name:
Other - Last Name:MUJAHID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:405 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3006
Mailing Address - Country:US
Mailing Address - Phone:609-716-7417
Mailing Address - Fax:
Practice Address - Street 1:405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3006
Practice Address - Country:US
Practice Address - Phone:847-441-5600
Practice Address - Fax:847-441-7968
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA081491002084H0002X
IL0361565712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64035793Medicaid
KYCAQH10478011OtherCREDENTIALLING SERV IDENT
188901Medicare ID - Type Unspecified
KYCAQH10478011OtherCREDENTIALLING SERV IDENT
G62158Medicare UPIN
KY64035793Medicare ID - Type Unspecified