NPIMap

Individual provider Active NPI

Tejan Khaldon Ottallah Elmariah, D.M.D

  • Dentist
  • Baltimore, MD
National Provider Identifier
1467835272
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
16093 Issued in MD
Practice address
1820 Lancaster St
# 100
Baltimore, MD 21231-3584
Phone
(410) 970-0440
NPI assigned
Jun 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 16093 MD Primary
Dentist 122300000X 21314 FL

Addresses

Primary practice location

1820 Lancaster St
# 100
Baltimore, MD 21231-3584

Mailing address

1820 Lancaster St
# 100
Baltimore, MD 21231-3584
Phone (410) 970-0440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21314FLMDDentist
16093MDMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1467835272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 LANCASTER ST",
            "address_2": "# 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212313584",
            "telephone_number": "410-970-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 LANCASTER ST",
            "address_2": "# 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212313584",
            "telephone_number": "410-970-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMARIAH",
        "first_name": "TEJAN",
        "middle_name": "KHALDON OTTALLAH",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16093",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "21314",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.