Provider Demographics
NPI:1790925493
Name:RAZAQ, MARIAM (DO)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:RAZAQ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 POST OFFICE RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1912
Mailing Address - Country:US
Mailing Address - Phone:240-754-7954
Mailing Address - Fax:240-754-7958
Practice Address - Street 1:601 POST OFFICE RD STE 2A
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1912
Practice Address - Country:US
Practice Address - Phone:240-754-7954
Practice Address - Fax:240-754-7958
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034267208100000X
MDH0067340208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD089763900Medicaid