Provider Demographics
NPI:1457429706
Name:NASIR, ADNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:
Last Name:NASIR
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 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:WAKE DERMATOLOGY, SUITE 408
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-781-1001
Mailing Address - Fax:919-781-3909
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:WAKE DERMATOLOGY, SUITE 408
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-781-1001
Practice Address - Fax:919-781-3909
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601682207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0124885OtherAETNA GROUP NUMBER
5814729OtherAETNA PIN NUMBER
2284204OtherAETNA PROVIDER NUMBER
2344640OtherMEDICARE GROUP NUMBER
NC02261OtherBLUE CROSS GROUP NUMBER
5814729OtherAETNA PIN NUMBER
2344640OtherMEDICARE GROUP NUMBER