MEDICARE: IRFAN AZAM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	MD458664	PA

General Provider Information

NPI Number	:	1902249980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRFAN AZAM

Provider Business Mailing Address
First Line	:	111 S 11TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-6180
Fax Number	:	215-955-6410

Provider Business Practice Location Address
First Line	:	2415 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4000
Country	:	US
Telephone Number	:	215-779-7040
Fax Number	:

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	05/23/2026

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Directions to “ IRFAN AZAM ” Practice Location

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