Basic Information
| Provider Information | |||||||||
| NPI: | 1336182179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EJAZ | ||||||||
| FirstName: | MUHAMMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 CHESAPEAKE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102286243 | ||||||||
| FaxNumber: | 4109014011 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 CHESAPEAKE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102286243 | ||||||||
| FaxNumber: | 4109014011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 10/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0052255 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.