Provider Demographics
NPI:1366519480
Name:RIAZ, SYED MOAZAM ALI (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:MOAZAM ALI
Last Name:RIAZ
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 1:500 S CAMP MEADE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2703
Mailing Address - Country:US
Mailing Address - Phone:410-691-2302
Mailing Address - Fax:410-691-2306
Practice Address - Street 1:500 S CAMP MEADE RD STE B
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2703
Practice Address - Country:US
Practice Address - Phone:410-691-2302
Practice Address - Fax:410-691-2306
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8976Medicare PIN