Provider Demographics
NPI:1740783752
Name:JEAN WALTER INFUSION CENTER, LLC
Entity Type:Organization
Organization Name:JEAN WALTER INFUSION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-744-0661
Mailing Address - Street 1:700 GEIPE ROAD ST. 100
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-744-0661
Mailing Address - Fax:410-744-8036
Practice Address - Street 1:700 GEIPE ROAD ST. 100
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:443-354-3772
Practice Address - Fax:410-744-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy