Provider Demographics
NPI:1760599575
Name:NASEERUDDIN, SYED AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:AHMED
Last Name:NASEERUDDIN
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 1:137 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5458
Mailing Address - Country:US
Mailing Address - Phone:615-229-5579
Mailing Address - Fax:931-919-4898
Practice Address - Street 1:137 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5458
Practice Address - Country:US
Practice Address - Phone:615-229-5579
Practice Address - Fax:931-542-1308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45618207P00000X, 207R00000X, 208M00000X
TN45045207P00000X, 207QS0010X
IL036.127417207QS0010X
GA67046207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514009Medicaid
TNP00725072OtherRR MEDICARE
TN103I82578Medicare PIN