1588804165 NPI number — DR. NISSRIN MAHMOUD EZMERLI MD

Table of content: DR. NISSRIN MAHMOUD EZMERLI MD (NPI 1588804165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588804165 NPI number — DR. NISSRIN MAHMOUD EZMERLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EZMERLI
Provider First Name:
NISSRIN
Provider Middle Name:
MAHMOUD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1588804165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12510 PROSPERITY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-485-5200
Provider Business Mailing Address Fax Number:
301-625-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10801 LOCKWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20901-1556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-593-2002
Provider Business Practice Location Address Fax Number:
301-593-4781
Provider Enumeration Date:
02/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  D70902 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com