Provider Demographics
NPI:1316190440
Name:TARIQ, NASREEN (MD)
Entity Type:Individual
Prefix:
First Name:NASREEN
Middle Name:
Last Name:TARIQ
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 1:212 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2038
Mailing Address - Country:US
Mailing Address - Phone:334-774-1555
Mailing Address - Fax:334-774-1505
Practice Address - Street 1:212 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2038
Practice Address - Country:US
Practice Address - Phone:334-774-1555
Practice Address - Fax:334-774-1505
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL29056OtherMEDICAL LICENSE
AL29056OtherCONTROLLED SUBSTANCE