Provider Demographics
NPI:1568545432
Name:NAZEMI, ATAOLLAH FILSOOF (MD)
Entity Type:Individual
Prefix:
First Name:ATAOLLAH
Middle Name:FILSOOF
Last Name:NAZEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 RIDGELEIGH CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1624
Mailing Address - Country:US
Mailing Address - Phone:410-377-6813
Mailing Address - Fax:410-377-6426
Practice Address - Street 1:6615 REISTERSTOWN RD STE 205A
Practice Address - Street 2:MD.PHYSCIANS ASSOC,
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2690
Practice Address - Country:US
Practice Address - Phone:410-486-2298
Practice Address - Fax:410-358-6551
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0017322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC49421Medicare UPIN