Provider Demographics
NPI:1336958354
Name:AHMADZAI, MALALAH
Entity type:Individual
Prefix:
First Name:MALALAH
Middle Name:
Last Name:AHMADZAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 WALNUT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5921
Mailing Address - Country:US
Mailing Address - Phone:585-957-5001
Mailing Address - Fax:
Practice Address - Street 1:2114 WALNUT RIDGE CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5921
Practice Address - Country:US
Practice Address - Phone:585-957-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10273238553171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter