Provider Demographics
NPI:1790958692
Name:ALAVI, REZA (MD, MHS, MBA)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:ALAVI
Suffix:
Gender:M
Credentials:MD, MHS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1113
Mailing Address - Country:US
Mailing Address - Phone:410-502-3469
Mailing Address - Fax:410-502-7387
Practice Address - Street 1:933 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1113
Practice Address - Country:US
Practice Address - Phone:410-502-3469
Practice Address - Fax:410-502-7387
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018870100Medicaid
MD245245Medicare PIN