Provider Demographics
NPI:1922194398
Name:KASHIF, FAHIM NADIR (PA-C)
Entity Type:Individual
Prefix:
First Name:FAHIM
Middle Name:NADIR
Last Name:KASHIF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 HOLABIRD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1700
Mailing Address - Country:US
Mailing Address - Phone:443-376-5785
Mailing Address - Fax:443-376-5715
Practice Address - Street 1:6730 HOLABIRD AVE STE 120
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1700
Practice Address - Country:US
Practice Address - Phone:443-376-5785
Practice Address - Fax:443-376-5715
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030413363A00000X
MDC0003457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant