Provider Demographics
NPI:1366494288
Name:NASSIRI, ROSTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSTAM
Middle Name:
Last Name:NASSIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13823 OUTLET DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4971
Mailing Address - Country:US
Mailing Address - Phone:301-890-8000
Mailing Address - Fax:301-890-1485
Practice Address - Street 1:13823 OUTLET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4971
Practice Address - Country:US
Practice Address - Phone:301-890-8000
Practice Address - Fax:301-890-1485
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDY50740Medicare UPIN
DCG02255R01Medicare PIN