Provider Demographics
NPI:1073613568
Name:ALAM, AZIZA C (MD)
Entity Type:Individual
Prefix:DR
First Name:AZIZA
Middle Name:C
Last Name:ALAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 ALTAMONT PLACE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695
Mailing Address - Country:US
Mailing Address - Phone:301-645-1781
Mailing Address - Fax:301-374-9237
Practice Address - Street 1:4255 ALTAMONT PLACE
Practice Address - Street 2:SUITE 301
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695
Practice Address - Country:US
Practice Address - Phone:301-645-1781
Practice Address - Fax:301-374-9237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022248208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1256AOtherBLUE SHIELD OF MD
DC4181OtherBLUE SHIELD OF DC
MDD78004Medicare UPIN