Provider Demographics
NPI:1013509439
Name:AZAR/FILIPOV MD PA
Entity Type:Organization
Organization Name:AZAR/FILIPOV MD PA
Other - Org Name:THE OPTICAL SHOP AT AZAR EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-546-2500
Mailing Address - Street 1:31519 WINTERPLACE PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1894
Mailing Address - Country:US
Mailing Address - Phone:410-546-2500
Mailing Address - Fax:
Practice Address - Street 1:116 E FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1725
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:410-546-5005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZAR FILIPOV MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD063341100Medicaid