Provider Demographics
NPI:1346363322
Name:MOAZZAM, CAROLINE S (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:S
Last Name:MOAZZAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:SMYTH BLDG, SUITE G-1; JHU-DEPARTMENT OF ORTHOPAEDICS-G
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239
Mailing Address - Country:US
Mailing Address - Phone:443-444-4517
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:SMYTH BLDG, SUITE G-1; JHU-DEPARTMENT OF ORTHOPAEDICS-G
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:443-444-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0072493207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery