Healthcare Provider Details

I. General information

NPI: 1669761342
Provider Name (Legal Business Name): PAKEEZA ALAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW DEPT OF OBSTETRICS AND GYNECOLOGY
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW DEPT OF OBSTETRICS AND GYNECOLOGY
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-0348
  • Fax: 202-877-6601
Mailing address:
  • Phone: 202-877-0348
  • Fax: 202-877-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberD0079180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: