Healthcare Provider Details

I. General information

NPI: 1548418825
Provider Name (Legal Business Name): DAVID AFZAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD SUITE 250
GAMBRILLS MD
21054-1690
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-1507
  • Fax: 410-721-1510
Mailing address:
  • Phone: 443-481-6576
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015630
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH75480
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: