Provider Demographics
NPI:1376838649
Name:SHABNAM NASEER DO, LLC
Entity Type:Organization
Organization Name:SHABNAM NASEER DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:NAHEED
Authorized Official - Last Name:NASEER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-966-2900
Mailing Address - Street 1:2235 GREENCEDAR DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:443-966-2900
Mailing Address - Fax:
Practice Address - Street 1:601 REVOLUTION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3319
Practice Address - Country:US
Practice Address - Phone:443-966-2899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0070575207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty