Provider Demographics
NPI:1861695603
Name:HAJJAR MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:HAJJAR MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-386-3303
Mailing Address - Street 1:17862 SR 247
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679
Mailing Address - Country:US
Mailing Address - Phone:937-386-3303
Mailing Address - Fax:937-386-3167
Practice Address - Street 1:17862 SR 247
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679
Practice Address - Country:US
Practice Address - Phone:937-386-3303
Practice Address - Fax:937-386-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067590H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0997417Medicaid
OH0997417Medicaid
OHF93120Medicare UPIN