Healthcare Provider Details

I. General information

NPI: 1184234098
Provider Name (Legal Business Name): AZAR/FILIPOV MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11031 NICHOLAS LN STE 2
BERLIN MD
21811-3296
US

IV. Provider business mailing address

11031 NICHOLAS LN STE 2
BERLIN MD
21811-3296
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2500
  • Fax:
Mailing address:
  • Phone: 410-546-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DONOWAY
Title or Position: CREDENTIALING COORDINATOR
Credential: RN
Phone: 410-546-2500