1639502313 NPI number — NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639502313 NPI number — NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639502313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 GEIPE RD
Provider Second Line Business Mailing Address:
ST. 200
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-744-0661
Provider Business Mailing Address Fax Number:
410-744-8036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3168 BRAVERTON ST STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037-2680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-0661
Provider Business Practice Location Address Fax Number:
410-744-8036
Provider Enumeration Date:
08/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MIHM
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-744-0661

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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