MEDICARE: DR. GHULAM MURTAZA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	13663	MD

General Provider Information

NPI Number	:	1982806691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHULAM MURTAZA D.M.D.

Provider Business Mailing Address
First Line	:	8808 CENTRE PARK DR
Second Line	:	SUITE 210
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2126
Country	:	US
Telephone Number	:	410-772-9600
Fax Number	:	410-772-0830

Provider Business Practice Location Address
First Line	:	8808 CENTRE PARK DR
Second Line	:	SUITE 210
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2126
Country	:	US
Telephone Number	:	410-772-9600
Fax Number	:	410-772-0830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	09/07/2012

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