Individual
SHAHANAWAZ JIWANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
459 MILLER DRIVE, ROOM 109, FREDERICK, MD 21702
(301) 846-7689
Mailing address
1821 WILLARD PL UNIT B, FREDERICK, MD 21702-1212
(240) 409-6779
Taxonomy
Speciality
Code
Description
License number
State
207SM0001X
Molecular Genetic Pathology (Medical Genetics) Physician
Primary
D0085605
MD
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/01/2013
Last updated
04/15/2022
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