Healthcare Provider Details

I. General information

NPI: 1225026149
Provider Name (Legal Business Name): MAHMAUD SHIRAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 ROYAL MILE BLVD
SALISBURY MD
21801-2318
US

IV. Provider business mailing address

PO BOX 64916
BALTIMORE MD
21264-4916
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 410-216-6481
  • Fax: 410-280-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: