Healthcare Provider Details

I. General information

NPI: 1427874627
Provider Name (Legal Business Name): HIBA USMANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

3910 SHAWFIELD LN
FREDERICK MD
21704-7905
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9000
  • Fax:
Mailing address:
  • Phone: 301-538-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: