Provider Demographics
NPI:1366601056
Name:AZOLA, ALBA MIRANDA (MD)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:MIRANDA
Last Name:AZOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALBA
Other - Middle Name:DEL MAR
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:600 N WOLFE STREET
Practice Address - Street 2:MEYER 1-163
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-614-4030
Practice Address - Fax:410-614-4033
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD89506208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation