Provider Demographics
NPI:1568400299
Name:AL-AZZAWI, BUSHRA I (MD)
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:I
Last Name:AL-AZZAWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 HOSPITAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4373
Mailing Address - Country:US
Mailing Address - Phone:443-559-5082
Mailing Address - Fax:443-559-5078
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:443-559-5082
Practice Address - Fax:443-559-5078
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3676417OtherAETNA HMO
MD345BBUOtherCAREFIRST BCBS MD
MD9858660OtherCIGNA
DCK1510001OtherCAREFIRST BCBS DC
MD406046600Medicaid
MD7676676OtherAETNA PPO
MD8133103OtherMD-IPA/OCI/MAMSI/ALLIANCE
DCK1510001OtherCAREFIRST BCBS DC
MD7676676OtherAETNA PPO