Provider Demographics
NPI:1083244305
Name:AZIZ, MELAD
Entity Type:Individual
Prefix:
First Name:MELAD
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 BRIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2415
Mailing Address - Country:US
Mailing Address - Phone:804-244-9526
Mailing Address - Fax:
Practice Address - Street 1:2437 BRIDGEVIEW LN
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2415
Practice Address - Country:US
Practice Address - Phone:804-244-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-26
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty