Provider Demographics
NPI:1144329285
Name:UDDIN, MAIRAJ (MD)
Entity type:Individual
Prefix:DR
First Name:MAIRAJ
Middle Name:
Last Name:UDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9677 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2526
Mailing Address - Country:US
Mailing Address - Phone:727-904-9096
Mailing Address - Fax:727-490-9299
Practice Address - Street 1:9677 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772
Practice Address - Country:US
Practice Address - Phone:727-490-9096
Practice Address - Fax:727-490-9299
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01115731OtherRR MCR
FLP01115731OtherRR MCR
AC044ZMedicare PIN