MEDICARE: BASHARAT JABEEN AZIZ MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	D21644	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K284	OTHER	MD	BCBS
2	R842	OTHER	MD	BLUE CHOICE

General Provider Information

NPI Number	:	1295824050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHARAT JABEEN AZIZ MD PA

Provider Business Mailing Address
First Line	:	7505 OSLER DRIVE
Second Line	:	SUITE 203 ATTN PEGGY
City	:	TOWSON
State	:	MD
Zip	:	21204-7737
Country	:	US
Telephone Number	:	410-823-1150
Fax Number	:	410-825-1636

Provider Business Practice Location Address
First Line	:	7505 OSLER DRIVE
Second Line	:	SUITE 203 ATTN PEGGY
City	:	TOWSON
State	:	MD
Zip	:	21204-7737
Country	:	US
Telephone Number	:	410-823-1150
Fax Number	:	410-825-1636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/01/2008

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