Healthcare Provider Details

I. General information

NPI: 1295645950
Provider Name (Legal Business Name): SAFA RIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

11629 QUARTERFIELD DR
ELLICOTT CITY MD
21042-1280
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-2212
  • Fax:
Mailing address:
  • Phone: 443-979-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: