Provider Demographics
NPI:1437698552
Name:SOUTHSIDE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:SOUTHSIDE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIMA
Authorized Official - Middle Name:NEELOFER
Authorized Official - Last Name:JAFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-978-7028
Mailing Address - Street 1:102 WILLIAMSPORT CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6400
Mailing Address - Country:US
Mailing Address - Phone:443-978-7028
Mailing Address - Fax:443-944-9023
Practice Address - Street 1:102 WILLIAMSPORT CIR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6400
Practice Address - Country:US
Practice Address - Phone:443-978-7028
Practice Address - Fax:443-944-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080104207R00000X
MDD0064352208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty