Provider Demographics
NPI:1710589619
Name:RAJA, FAIZA MAHMOOD
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:MAHMOOD
Last Name:RAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 JOHNNYCAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2418
Mailing Address - Country:US
Mailing Address - Phone:410-744-5437
Mailing Address - Fax:
Practice Address - Street 1:7001 JOHNNYCAKE RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2418
Practice Address - Country:US
Practice Address - Phone:410-744-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant