Provider Demographics
NPI:1669425120
Name:NAZAR, QAYYUM (MD)
Entity type:Individual
Prefix:
First Name:QAYYUM
Middle Name:
Last Name:NAZAR
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 1:1993 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1708
Mailing Address - Country:US
Mailing Address - Phone:302-838-3100
Mailing Address - Fax:667-215-0937
Practice Address - Street 1:1993 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1708
Practice Address - Country:US
Practice Address - Phone:302-838-3100
Practice Address - Fax:667-215-0937
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64083207RA0000X
WAMD00039324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8284796Medicaid
WA8284796Medicaid