Provider Demographics
NPI:1629277280
Name:NASSER NABI MD PC
Entity Type:Organization
Organization Name:NASSER NABI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:NABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-698-2775
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-698-2775
Mailing Address - Fax:617-698-2778
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-698-2775
Practice Address - Fax:617-698-2778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSER NABI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA033570207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0154121Medicaid
MANAC18071OtherBCBS
MAA53785Medicare UPIN
MANAC18071OtherBCBS