Healthcare Provider Details

I. General information

NPI: 1366767824
Provider Name (Legal Business Name): SANAM D RAZEGHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2010
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 410
LAUREL MD
20707-5265
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE 410
LAUREL MD
20707-5265
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-498-7346
Mailing address:
  • Phone: 301-498-5500
  • Fax: 301-498-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD458802
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0092670
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: