Provider Demographics
NPI:1619232758
Name:AZAM, MOHAMMED ASHFAQ (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ASHFAQ
Last Name:AZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASHI
Other - Middle Name:
Other - Last Name:AZAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17818 THOMAS VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1341
Mailing Address - Country:US
Mailing Address - Phone:678-613-2236
Mailing Address - Fax:
Practice Address - Street 1:13121 BROOKLANE DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1514
Practice Address - Country:US
Practice Address - Phone:301-733-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0438112084P0800X
VA01012685072084P0800X
MDD00966722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry