Provider Demographics
NPI:1689815888
Name:MOIDUDDIN, NASSER (MD)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:MOIDUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NASSER
Other - Middle Name:JUNAID
Other - Last Name:MOIDUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8000
Mailing Address - Fax:
Practice Address - Street 1:333 N SANTA ROSA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0101207RA0002X, 2080P0202X
CAA109143207RA0002X, 2080P0202X, 208000000X
MI4301087407208000000X, 2080P0202X
WV272372080P0202X
OH350945402080P0202X
TXU8223207RA0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05930OtherPARAMOUNT
OH9766413OtherAETNA
OH3007356OtherBCMH
OH000000645226OtherANTHEM
OH3007356Medicaid
OH3007356Medicaid