Provider Demographics
NPI:1164476362
Name:HAJJAR, ATHIR J (MD)
Entity type:Individual
Prefix:
First Name:ATHIR
Middle Name:J
Last Name:HAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ATHIR
Other - Middle Name:J
Other - Last Name:MEROGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:671 S MOLLISON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6618
Mailing Address - Country:US
Mailing Address - Phone:619-841-8148
Mailing Address - Fax:844-350-9978
Practice Address - Street 1:671 S MOLLISON AVE
Practice Address - Street 2:SUITE B & C
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-841-8148
Practice Address - Fax:844-350-9978
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114867207RP1001X, 207RC0200X
INCV2200566207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114867Medicaid
IL036114867Medicaid
K24567Medicare PIN
CACB228869Medicare UPIN