Healthcare Provider Details

I. General information

NPI: 1730575952
Provider Name (Legal Business Name): ZULARA NAWAZ WAHLA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-4680
  • Fax: 207-622-4085
Mailing address:
  • Phone: 207-621-4680
  • Fax: 207-622-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number25MA10799000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD25097
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: