Provider Demographics
NPI:1528038585
Name:GARY, NADER G (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:G
Last Name:GARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NADER
Other - Middle Name:
Other - Last Name:GHARAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 NORTH POINT BLVD
Mailing Address - Street 2:STE 704
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-282-6767
Mailing Address - Fax:410-282-3777
Practice Address - Street 1:1005 NORTH POINT BLVD
Practice Address - Street 2:STE 704
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-282-6767
Practice Address - Fax:410-282-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD015770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05297Medicaid
22894OtherMAMSI
MD32036006OtherCAREFIRST BCBS
MD05297Medicaid
22894OtherMAMSI