Healthcare Provider Details

I. General information

NPI: 1235370024
Provider Name (Legal Business Name): HUMMA ISHAQ TIWANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST GRUEHN BLDG., SUITE 301
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

3001 S HANOVER ST GRUEHN BLDG., SUITE 301
BALTIMORE MD
21225-1233
US

V. Phone/Fax

Practice location:
  • Phone: 410-354-0800
  • Fax: 410-354-0847
Mailing address:
  • Phone: 410-354-0800
  • Fax: 410-354-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD68575
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: