Provider Demographics
NPI:1972563518
Name:TAJICK, ALIREZA (MD)
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:TAJICK
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 1:12 GILL ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1728
Mailing Address - Country:US
Mailing Address - Phone:781-937-4522
Mailing Address - Fax:781-937-4510
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:540-349-6575
Practice Address - Fax:781-937-4510
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972563518Medicaid
VA014455V57Medicare PIN
VA1972563518Medicaid
NJI44761Medicare UPIN