Provider Demographics
NPI:1811228976
Name:SHIRAZI, NASSER MAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:MAJID
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-3835
Mailing Address - Country:US
Mailing Address - Phone:860-679-4888
Mailing Address - Fax:860-679-1153
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-3835
Practice Address - Country:US
Practice Address - Phone:860-679-4888
Practice Address - Fax:860-679-1153
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51133207R00000X
CT051133207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT51133OtherLICENSE