Provider Demographics
NPI:1265188742
Name:NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Entity type:Organization
Organization Name:NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-0661
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-744-0661
Mailing Address - Fax:410-744-8036
Practice Address - Street 1:724 MAIDEN CHOICE LN STE 204
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5964
Practice Address - Country:US
Practice Address - Phone:410-744-0661
Practice Address - Fax:410-744-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD902MOtherMEDICARE