Provider Demographics
NPI:1992788137
Name:NGAIZA, JUSTINIAN (MD)
Entity type:Individual
Prefix:
First Name:JUSTINIAN
Middle Name:
Last Name:NGAIZA
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 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-749-1282
Mailing Address - Fax:410-749-7821
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-749-1282
Practice Address - Fax:410-749-7821
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66198207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
478364OtherUS HEALTH CARE
017081OtherBLUE SHIELD OF VA
830007450OtherMC TRAVELERS
3600054OtherUNITED HEALTH CARE
281223OtherAMERIGROUP
3738OtherBLUE SHIELD OF DC GRP
37380006OtherCAPITAL CARE
0006OtherBLUE SHIELD OF DC
259622OtherALLIANCE MDIPA
478364OtherUS HEALTH CARE