Healthcare Provider Details

I. General information

NPI: 1568432797
Provider Name (Legal Business Name): GHULAM WARIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 SNOW HILL RD
SALISBURY MD
21804-1939
US

IV. Provider business mailing address

1200 RIVERPLACE BLVD SUITE 620
JACKSONVILLE FL
32207-9046
US

V. Phone/Fax

Practice location:
  • Phone: 410-572-6264
  • Fax:
Mailing address:
  • Phone: 904-396-6620
  • Fax: 904-396-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0058410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: