Provider Demographics
NPI:1639281736
Name:MUMTAZ, ANWAR (MD)
Entity Type:Individual
Prefix:
First Name:ANWAR
Middle Name:
Last Name:MUMTAZ
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 1:4000 ANNAPOLIS RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3600
Mailing Address - Country:US
Mailing Address - Phone:410-789-2800
Mailing Address - Fax:
Practice Address - Street 1:4000 ANNAPOLIS RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3600
Practice Address - Country:US
Practice Address - Phone:410-789-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024062207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD040000521OtherRAILROAD MEDICARE #
MD031911200Medicaid
MDA316OtherBLUECHOICE #
MD6298AOtherCAREFIRST MARYLAND #
MDA316OtherBLUECHOICE #
MD6298AOtherCAREFIRST MARYLAND #