Healthcare Provider Details

I. General information

NPI: 1962452045
Provider Name (Legal Business Name): SARA AZRA VAZER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 SHADY GROVE RD SUITE 140
ROCKVILLE MD
20850-4008
US

IV. Provider business mailing address

15825 SHADY GROVE RD SUITE 140
ROCKVILLE MD
20850-4008
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-9776
  • Fax: 301-216-2592
Mailing address:
  • Phone: 301-869-9776
  • Fax: 301-216-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0061298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: