Provider Demographics
NPI:1811029242
Name:AZAR, ANTOINE (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:AZAR
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:PO BOX 64264
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4264
Mailing Address - Country:US
Mailing Address - Phone:410-550-2300
Mailing Address - Fax:
Practice Address - Street 1:5501 HOPKINS BAYVIEW CIR
Practice Address - Street 2:ROOM 2A62
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6821
Practice Address - Country:US
Practice Address - Phone:410-550-2300
Practice Address - Fax:410-550-1733
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78997207RA0201X
IA37111207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD093272800Medicaid
MD7624997OtherAETNA/USHC
MD7624997OtherAETNA/USHC