Provider Demographics
NPI:1386685923
Name:JAMAL, NASIRUDDIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:NASIRUDDIN
Middle Name:M
Last Name:JAMAL
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 1:5029 E MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7622
Mailing Address - Country:US
Mailing Address - Phone:713-474-7294
Mailing Address - Fax:607-770-0853
Practice Address - Street 1:5029 E MICHELLE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-7622
Practice Address - Country:US
Practice Address - Phone:713-474-7294
Practice Address - Fax:607-770-0853
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123352207RC0000X, 207RI0011X
AZ56310207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00412262Medicaid
CC3480Medicare ID - Type Unspecified
NY00412262Medicaid