Healthcare Provider Details

I. General information

NPI: 1891856357
Provider Name (Legal Business Name): DR IRWIN AZMAN & DR THOMAS AZMAN ODS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 CLARKVIEW RD STE 200
BALTIMORE MD
21209-2100
US

IV. Provider business mailing address

1427 CLARKVIEW RD STE 200
BALTIMORE MD
21209-2100
US

V. Phone/Fax

Practice location:
  • Phone: 410-561-8050
  • Fax: 410-561-8055
Mailing address:
  • Phone: 410-561-8050
  • Fax: 410-561-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE ELLINGSWORTH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 410-561-8050