Provider Demographics
NPI:1396996385
Name:ANAIZI, AMJAD NASR (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:NASR
Last Name:ANAIZI
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 1:10401 HOSPITAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3110
Mailing Address - Country:US
Mailing Address - Phone:301-856-2323
Mailing Address - Fax:301-856-0477
Practice Address - Street 1:10401 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3110
Practice Address - Country:US
Practice Address - Phone:301-856-2323
Practice Address - Fax:301-856-0477
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076394207T00000X
DCMD040139207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD555304100Medicaid
DC084050700Medicaid
DC306364YTZMedicare PIN
DC084050700Medicaid