Provider Demographics
NPI:1679527188
Name:GAZI, MUKARAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKARAM
Middle Name:A
Last Name:GAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUKARAM
Other - Middle Name:A
Other - Last Name:GAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3701
Mailing Address - Country:US
Mailing Address - Phone:609-581-5900
Mailing Address - Fax:609-581-5901
Practice Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3701
Practice Address - Country:US
Practice Address - Phone:609-581-5900
Practice Address - Fax:609-581-5901
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06709800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH53618Medicare UPIN