Provider Demographics
NPI:1669461760
Name:NAZIR, GULSHAN
Entity Type:Individual
Prefix:DR
First Name:GULSHAN
Middle Name:
Last Name:NAZIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5267
Mailing Address - Country:US
Mailing Address - Phone:301-560-4747
Mailing Address - Fax:301-776-1725
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:STE 130
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5267
Practice Address - Country:US
Practice Address - Phone:301-560-4747
Practice Address - Fax:301-776-1725
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061533207Q00000X
NY01012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB8014Medicare ID - Type Unspecified
NY00010124Medicaid
NYH07395Medicare UPIN