Healthcare Provider Details

I. General information

NPI: 1275799330
Provider Name (Legal Business Name): AYESHA IQBAL M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 LANIER AVE
BALTIMORE MD
21215-5343
US

IV. Provider business mailing address

4927 LANIER AVE
BALTIMORE MD
21215-5343
US

V. Phone/Fax

Practice location:
  • Phone: 469-274-7209
  • Fax:
Mailing address:
  • Phone: 469-274-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP22855
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: