Healthcare Provider Details

I. General information

NPI: 1275528879
Provider Name (Legal Business Name): FARIBA AZIZINAMINI D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 MOLECULAR DR STE 114
ROCKVILLE MD
20850-7538
US

IV. Provider business mailing address

10110 MOLECULAR DR STE 114
ROCKVILLE MD
20850-7538
US

V. Phone/Fax

Practice location:
  • Phone: 301-780-4745
  • Fax: 301-605-7550
Mailing address:
  • Phone: 301-780-4745
  • Fax: 301-605-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: