Provider Demographics
NPI:1548571607
Name:NEJAD, ALIREZA SADEGH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:SADEGH
Last Name:NEJAD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:SADEGH NEJAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:11350 MCCORMICK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21065-9998
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:11350 MCCORMICK RD STE 102
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21065-9998
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0075718207K00000X, 207RA0201X
PAMD454754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology