Provider Demographics
NPI:1467550236
Name:AZIM, MOHAMMED HAROON (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:HAROON
Last Name:AZIM
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 1:8694 CENTREVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5266
Mailing Address - Country:US
Mailing Address - Phone:703-257-1996
Mailing Address - Fax:703-361-6078
Practice Address - Street 1:8694 CENTREVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5266
Practice Address - Country:US
Practice Address - Phone:703-257-1996
Practice Address - Fax:703-361-6078
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236183207Q00000X
VA0101049112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14078Medicare UPIN