Provider Demographics
NPI:1861642746
Name:BASHARAT JABEEN AZIZ MD PA
Entity Type:Organization
Organization Name:BASHARAT JABEEN AZIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHARAT
Authorized Official - Middle Name:JABEEN
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:410-823-1150
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7737
Mailing Address - Country:US
Mailing Address - Phone:410-823-1150
Mailing Address - Fax:410-825-1636
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:410-823-1150
Practice Address - Fax:410-825-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE10907Medicare UPIN