Healthcare Provider Details

I. General information

NPI: 1073477949
Provider Name (Legal Business Name): IZAIAH PLAZA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWAY CENTER DR STE 1300
GREENBELT MD
20770-3575
US

IV. Provider business mailing address

2288 BLUE WATER BLVD STE 310
ODENTON MD
21113-3301
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-9595
  • Fax: 877-394-2171
Mailing address:
  • Phone: 240-342-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: