Provider Demographics
NPI: | 1508850538 |
---|---|
Name: | JAFRI, S NAYYER HUSSEIN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | S NAYYER |
Middle Name: | HUSSEIN |
Last Name: | JAFRI |
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: | PO BOX 951427 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEVELAND |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44193-0016 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-457-8180 |
Mailing Address - Fax: | 614-442-2414 |
Practice Address - Street 1: | 793 W STATE ST |
Practice Address - Street 2: | MCW HOSPITAL PATHOLOGY DEPT |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43222-1551 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-234-5819 |
Practice Address - Fax: | 614-234-2931 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-06 |
Last Update Date: | 2010-11-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35075606 | 207ZP0102X, 207ZC0500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2097136 | Medicaid | |
OH | 2097136 | Medicaid |