Provider Demographics
NPI:1124189592
Name:IJAZ, MOHAMMAD TUFAIL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:TUFAIL
Last Name:IJAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2315 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2028
Mailing Address - Country:US
Mailing Address - Phone:740-586-6690
Mailing Address - Fax:740-453-3406
Practice Address - Street 1:2315 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2028
Practice Address - Country:US
Practice Address - Phone:740-586-6690
Practice Address - Fax:740-453-3406
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093167207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939262Medicaid
OHI01386Medicare UPIN