Provider Demographics
NPI:1700106200
Name:AWAN, YOUSAF (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSAF
Middle Name:
Last Name:AWAN
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 1:1365 BOYLSTON ST
Mailing Address - Street 2:UNIT #252
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3912
Mailing Address - Country:US
Mailing Address - Phone:443-527-1984
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-5201
Practice Address - Fax:410-601-9481
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD754402085R0202X
DCMD0478322085R0202X
390200000X
DEC7-0004574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine