Provider Demographics
NPI:1356560460
Name:MATEEN A. AWAN MD LLC
Entity type:Organization
Organization Name:MATEEN A. AWAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:MATEEN
Authorized Official - Middle Name:AFZAL
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-992-9355
Mailing Address - Street 1:10802 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3622
Mailing Address - Country:US
Mailing Address - Phone:410-992-9355
Mailing Address - Fax:410-992-3447
Practice Address - Street 1:10802 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-992-9355
Practice Address - Fax:410-992-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H 26575Medicare UPIN
MD183P422GMedicare ID - Type Unspecified