Provider Demographics
NPI:1912920257
Name:AFZAL, UZMA (PA)
Entity Type:Individual
Prefix:
First Name:UZMA
Middle Name:
Last Name:AFZAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 DEFENSE HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2926
Mailing Address - Country:US
Mailing Address - Phone:410-721-5280
Mailing Address - Fax:410-721-2243
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:STE 103
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2926
Practice Address - Country:US
Practice Address - Phone:410-721-5280
Practice Address - Fax:410-721-2243
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002658363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD904200800Medicaid
MDKT93, LT35 /OtherBC / BS OF MD
MDS186 /OtherBLUECHOICE
165L /Medicare ID - Type Unspecified