Provider Demographics
NPI:1265482368
Name:SHAWL, FAYAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYAZ
Middle Name:A
Last Name:SHAWL
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 1:7620 CARROLL AVE
Mailing Address - Street 2:#200
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6387
Mailing Address - Country:US
Mailing Address - Phone:301-891-8570
Mailing Address - Fax:301-891-0630
Practice Address - Street 1:7620 CARROLL AVE
Practice Address - Street 2:#200
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6387
Practice Address - Country:US
Practice Address - Phone:301-891-8570
Practice Address - Fax:301-891-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD793851900Medicaid
MN1265482368OtherINDIVIDUAL NPI
MD415988Medicare PIN
MD793851900Medicaid