Provider Demographics
NPI:1851596365
Name:MUSHTAQ, ALVINA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ALVINA
Middle Name:
Last Name:MUSHTAQ
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 LOST CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2920
Mailing Address - Country:US
Mailing Address - Phone:703-624-0057
Mailing Address - Fax:
Practice Address - Street 1:2004 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2607
Practice Address - Country:US
Practice Address - Phone:443-567-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine