Provider Demographics
NPI:1679535405
Name:DAJANI, TALA SERI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:TALA
Middle Name:SERI
Last Name:DAJANI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SUNWEST DR
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8550
Mailing Address - Country:US
Mailing Address - Phone:704-403-2660
Mailing Address - Fax:704-782-6032
Practice Address - Street 1:100 MEDICAL PARK DR STE 310E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2966
Practice Address - Country:US
Practice Address - Phone:704-403-2660
Practice Address - Fax:704-782-6032
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ288372080P0205X
NC2021-033572080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107635OtherMEDICARE NUMBER
AZ882284Medicaid
AZ107635OtherMEDICARE NUMBER