Provider Demographics
NPI:1255409082
Name:TRI-STATE HEALTH, INC.
Entity type:Organization
Organization Name:TRI-STATE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-392-6408
Mailing Address - Street 1:107 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5326
Mailing Address - Country:US
Mailing Address - Phone:410-392-6408
Mailing Address - Fax:410-392-4809
Practice Address - Street 1:107 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5326
Practice Address - Country:US
Practice Address - Phone:410-392-6408
Practice Address - Fax:410-392-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401409000Medicaid
MD555MMedicare ID - Type Unspecified