Provider Demographics
NPI:1205842341
Name:ZAFAR, NADAH BANO (MD)
Entity Type:Individual
Prefix:
First Name:NADAH
Middle Name:BANO
Last Name:ZAFAR
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 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5120
Mailing Address - Fax:401-444-4307
Practice Address - Street 1:10 ORMS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2228
Practice Address - Country:US
Practice Address - Phone:401-444-5120
Practice Address - Fax:401-444-4307
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11224207P00000X
TXN1500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7050066Medicaid
TXP01047398OtherMEDICARE RAILROAD
NM60451033Medicaid
RI007050066Medicare ID - Type Unspecified
NM60451033Medicaid
RIF87392Medicare UPIN