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General NPI Number Information
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NPI Number | 1619232758
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Entity Type | Individual
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Provider Name | MOHAMMED ASHFAQ AZAM MD
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Gender | Male
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Dates
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Enumeration Date | 07/04/2012
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 13121 BROOKLANE DR
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1514
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Country | US
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Telephone | 301-733-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 17818 THOMAS VILLAGE LN
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City | SANDY SPRING
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State | MD
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Zip | 20860-1341
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Country | US
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Telephone | 678-613-2236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD043811
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101268507
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0096672
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License Number State | MD
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