Provider Demographics
NPI:1124021415
Name:NAHRA, RAJAA (MD)
Entity Type:Individual
Prefix:
First Name:RAJAA
Middle Name:
Last Name:NAHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 S GLEN RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4131
Mailing Address - Country:US
Mailing Address - Phone:603-557-8446
Mailing Address - Fax:
Practice Address - Street 1:10005 S GLEN RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4131
Practice Address - Country:US
Practice Address - Phone:603-557-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211096207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH55332Medicare UPIN
MAA33595Medicare ID - Type Unspecified