Provider Demographics
NPI:1295824050
Name:AZIZ, BASHARAT JABEEN (MD PA)
Entity Type:Individual
Prefix:
First Name:BASHARAT
Middle Name:JABEEN
Last Name:AZIZ
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DRIVE
Mailing Address - Street 2:SUITE 203 ATTN PEGGY
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7737
Mailing Address - Country:US
Mailing Address - Phone:410-823-1150
Mailing Address - Fax:410-825-1636
Practice Address - Street 1:7505 OSLER DRIVE
Practice Address - Street 2:SUITE 203 ATTN PEGGY
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:410-823-1150
Practice Address - Fax:410-825-1636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21644207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK284OtherBCBS
MDR842OtherBLUE CHOICE
MDR842OtherBLUE CHOICE
MDK284Medicare ID - Type Unspecified