Healthcare Provider Details

I. General information

NPI: 1366677239
Provider Name (Legal Business Name): ROHAN HAZRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 EXECUTIVE BLVD
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

11912 REYNOLDS AVE
POTOMAC MD
20854-3333
US

V. Phone/Fax

Practice location:
  • Phone: 301-435-6868
  • Fax:
Mailing address:
  • Phone: 301-435-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number159063
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: