Provider Demographics
NPI:1184234098
Name:AZAR/FILIPOV MD PA
Entity type:Organization
Organization Name:AZAR/FILIPOV MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:11031 NICHOLAS LN STE 2
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3296
Mailing Address - Country:US
Mailing Address - Phone:410-546-2500
Mailing Address - Fax:
Practice Address - Street 1:11031 NICHOLAS LN STE 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3296
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZAR/FILIPOV MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD063341100Medicaid