Provider Demographics
NPI:1558384412
Name:MASSIH, NOSRAT A (MD)
Entity Type:Individual
Prefix:DR
First Name:NOSRAT
Middle Name:A
Last Name:MASSIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 SOUTH 73RD STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2348
Mailing Address - Country:US
Mailing Address - Phone:402-397-3626
Mailing Address - Fax:402-397-3993
Practice Address - Street 1:2430 SOUTH 73RD STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2348
Practice Address - Country:US
Practice Address - Phone:402-397-3626
Practice Address - Fax:402-397-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0400140OtherUNITED HEALTHCARE
NE42103792213Medicaid
IA0044990Medicaid
NE0400139OtherUNITED HEALTH CARE
NEB17971Medicare UPIN
IA0400140OtherUNITED HEALTHCARE
IA00220Medicare ID - Type Unspecified