Provider Demographics
NPI:1417161209
Name:POURSHARIF, NAEEM (DO)
Entity Type:Individual
Prefix:
First Name:NAEEM
Middle Name:
Last Name:POURSHARIF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 NEW TECHNOLOGY WAY
Mailing Address - Street 2:ANES: ADULT CARDIOTHORACIC ANESTHESIOLOGY
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8370
Mailing Address - Country:US
Mailing Address - Phone:240-566-1647
Mailing Address - Fax:
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:ANES: ADULT CARDIOTHORACIC ANESTHESIOLOGY
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202556390200000X, 207L00000X
MDH72945207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program