Healthcare Provider Details

I. General information

NPI: 1265621031
Provider Name (Legal Business Name): ASGHAR ALI FAKHRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4000
  • Fax:
Mailing address:
  • Phone: 410-787-4607
  • Fax: 410-595-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD85352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: