Healthcare Provider Details

I. General information

NPI: 1306890611
Provider Name (Legal Business Name): MOHAMMAD BASIT AFZAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E PULASKI HWY STE 1B
ELKTON MD
21921-6057
US

IV. Provider business mailing address

677 E PULASKI HWY STE 1B
ELKTON MD
21921-6057
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0215
  • Fax: 443-593-3725
Mailing address:
  • Phone: 410-398-0215
  • Fax: 443-593-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0066102
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberD0066102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: