Provider Demographics
NPI:1508037052
Name:MIRZA M. NUSAIREE, MD.
Entity Type:Organization
Organization Name:MIRZA M. NUSAIREE, MD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NUSAIREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-766-4747
Mailing Address - Street 1:1401 MADISON PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5881
Mailing Address - Country:US
Mailing Address - Phone:410-766-4747
Mailing Address - Fax:410-766-4855
Practice Address - Street 1:1401 MADISON PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5881
Practice Address - Country:US
Practice Address - Phone:410-766-4747
Practice Address - Fax:410-766-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty