Provider Demographics
NPI:1497728760
Name:IJAZ, MOHSIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSIN
Middle Name:
Last Name:IJAZ
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 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-816-9000
Mailing Address - Fax:301-816-0295
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-816-9000
Practice Address - Fax:301-816-0295
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053601207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2926A89Medicare PIN
G90120Medicare UPIN
DC131758YG94Medicare PIN