Provider Demographics
NPI:1316918303
Name:AWAN, MATEEN A (MD)
Entity type:Individual
Prefix:DR
First Name:MATEEN
Middle Name:A
Last Name:AWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8757 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763
Mailing Address - Country:US
Mailing Address - Phone:301-604-3413
Mailing Address - Fax:
Practice Address - Street 1:10802 HICKORY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-992-9355
Practice Address - Fax:410-992-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062634174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist