Healthcare Provider Details

I. General information

NPI: 1578530283
Provider Name (Legal Business Name): HUMA HAIDER WASI M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W ROLLING CROSSROADS SUITE 106
BALTIMORE MD
21228-6208
US

IV. Provider business mailing address

11911 HUNTERS RUN DR
COCKEYSVILLE MD
21030-1959
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-9894
  • Fax:
Mailing address:
  • Phone: 410-527-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0061050
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: