Provider Demographics
NPI:1942692587
Name:HAZRATI, ALIREZA (CRFNP-BC)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:HAZRATI
Suffix:
Gender:M
Credentials:CRFNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 THOMAS JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4501
Mailing Address - Country:US
Mailing Address - Phone:301-694-9033
Mailing Address - Fax:301-694-6204
Practice Address - Street 1:74 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4501
Practice Address - Country:US
Practice Address - Phone:301-694-9033
Practice Address - Fax:301-694-6204
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000180274163W00000X
MDAC001852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
6445113OtherAETNA
5508603OtherCIGNA
6734677OtherUNITED HEALTHCARE
MD794014900Medicaid
1459-0013OtherCAREFIRST
342524OtherJOHNS HOPKINS HEALTHCARE
652580OtherMEDICARE
P02079605OtherRAILROAD MEDICARE