=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194831925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBREEN IJAZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 361 OLD BELGRADE RD HAROLD ALFOND CENTER FOR CANCER CARE
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330-8058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-621-6100
-----------------------------------------------------
Fax | 207-621-6102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 361 OLD BELGRADE RD HAROLD ALFOND CENTER FOR CANCER CARE
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330-8058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-621-6100
-----------------------------------------------------
Fax | 207-621-6102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 80925
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 018699
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 235693
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------