Provider Demographics
NPI:1497738934
Name:NASIR, MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:MAHMOOD
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 1:512 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2338
Mailing Address - Country:US
Mailing Address - Phone:570-286-9878
Mailing Address - Fax:570-286-9848
Practice Address - Street 1:512 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2338
Practice Address - Country:US
Practice Address - Phone:570-286-9878
Practice Address - Fax:570-286-9848
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039921Y2084N0600X, 2084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7043863OtherGATEWAY
J43863OtherAMERIHEALTH
043863OtherKEYSTONE
PA5057095OtherAETNA
PA043863OtherPA BLUE SHIELD
130008812OtherRAILROAD MEDICARE
205802OtherBLACK LUNG
0012780720003OtherPA MEDICAL ASSISTANCE
01076501OtherCAPITAL BLUE CROSS
232750024OtherTRICARE
MD039921YOtherPA LICENSE
PA5057095OtherAETNA
043863OtherKEYSTONE
PA7043863OtherGATEWAY