Provider Demographics
NPI:1487946661
Name:AIVAZ, OHARA
Entity type:Individual
Prefix:
First Name:OHARA
Middle Name:
Last Name:AIVAZ
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 1:110 IRVING ST NW
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE/DERMATOLOGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-6654
Mailing Address - Fax:202-877-3288
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE/DERMATOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-6654
Practice Address - Fax:202-877-3288
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA145230207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program