1942692587 NPI number — ALIREZA HAZRATI CRFNP-BC

Table of content: ALIREZA HAZRATI CRFNP-BC (NPI 1942692587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942692587 NPI number — ALIREZA HAZRATI CRFNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZRATI
Provider First Name:
ALIREZA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRFNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942692587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-694-9033
Provider Business Mailing Address Fax Number:
301-694-6204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-9033
Provider Business Practice Location Address Fax Number:
301-694-6204
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN0000180274 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AC001852 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6445113 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5508603 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6734677 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 794014900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1459-0013 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 342524 . This is a "JOHNS HOPKINS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 652580 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P02079605 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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