Basic Information
Provider Information
NPI: 1447427893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AYAZI
FirstName: FARZAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: SUITE 6W PPQA
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018165853
FaxNumber:  
Practice Location
Address1: 1500 FOREST GLEN RD
Address2:  
City: SILVER SPRING
State: MD
PostalCode: 209101460
CountryCode: US
TelephoneNumber: 3013730391
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2008
LastUpdateDate: 06/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X00DCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home