Provider Demographics
NPI:1225000524
Name:MUDARRIS, FAYSAL (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYSAL
Middle Name:
Last Name:MUDARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373A REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3617
Mailing Address - Country:US
Mailing Address - Phone:410-356-8186
Mailing Address - Fax:410-356-4180
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:STE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-8186
Practice Address - Fax:410-356-4180
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00222012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2849OtherB/C B/S
MDJ062OtherB/C B/S
MDKA80OtherB/C B/S
MD434LN079Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MDJ062OtherB/C B/S
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDKA80OtherB/C B/S
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD435LN078Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02
MD018591A00Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 99