Provider Demographics
NPI:1841209822
Name:MARUF, NIZAMUDDIN JAINUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NIZAMUDDIN
Middle Name:JAINUDDIN
Last Name:MARUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:STE 503
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-1700
Practice Address - Fax:301-530-0418
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30503208800000X
MDD0047192208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD463500100Medicaid
B58319Medicare UPIN
MD463500100Medicaid
492103OtherNCPPO UNICARE
117762OtherVA BLUE SHIELD ANTHEM
DC0202OtherCAREFIRST BCBS
182887OtherVA BLUE SHIELD ANTHEM
2175025OtherAETNA US HEALTHCARE
MDKD82UROtherCAREFIRST BCBS
1900054OtherUNITED HLTHCARE EVERCARE
B58319Medicare UPIN
2215477OtherCIGNA
1900615OtherUNITED HEALTHCARE
909327OtherFIRST HEALTH
30488OtherJOHNS HOPKINS HEALTHCARE
4027350OtherAETNA US HEALTHCARE