Healthcare Provider Details

I. General information

NPI: 1366317646
Provider Name (Legal Business Name): IDI USMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9277 CARTERSVILLE RD
COLUMBIA MD
21046-1603
US

IV. Provider business mailing address

9277 CARTERSVILLE RD
COLUMBIA MD
21046-1603
US

V. Phone/Fax

Practice location:
  • Phone: 262-744-0357
  • Fax:
Mailing address:
  • Phone: 262-744-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR238126
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: