Provider Demographics
NPI:1255907051
Name:AGA, AZEB MOLLA
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:MOLLA
Last Name:AGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 WINSOME CIR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2165
Mailing Address - Country:US
Mailing Address - Phone:240-565-7283
Mailing Address - Fax:
Practice Address - Street 1:955 LENFANT PLZ SW STE 985
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-6104
Practice Address - Country:US
Practice Address - Phone:202-895-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator