Provider Demographics
NPI:1134126360
Name:JAZAYERLI, NABIL (MD)
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:JAZAYERLI
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:PO BOX 1692
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1692
Mailing Address - Country:US
Mailing Address - Phone:301-759-3817
Mailing Address - Fax:301-759-3286
Practice Address - Street 1:715 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6390
Practice Address - Country:US
Practice Address - Phone:301-759-3817
Practice Address - Fax:301-759-3286
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40736207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70949Medicare UPIN
MD433LMedicare ID - Type Unspecified