Provider Demographics
NPI:1194451211
Name:AL-NAWAFLH, MUTAZ (MD)
Entity type:Individual
Prefix:
First Name:MUTAZ
Middle Name:
Last Name:AL-NAWAFLH
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 1:445 ELMCROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5667
Mailing Address - Country:US
Mailing Address - Phone:202-468-6664
Mailing Address - Fax:
Practice Address - Street 1:445 ELMCROFT BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5667
Practice Address - Country:US
Practice Address - Phone:202-468-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ24190207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist