Provider Demographics
NPI:1669659983
Name:ISLAM, NAHID A (MD)
Entity type:Individual
Prefix:DR
First Name:NAHID
Middle Name:A
Last Name:ISLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 OLIVER RD
Mailing Address - Street 2:SUITE 1600B
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5702
Mailing Address - Country:US
Mailing Address - Phone:318-327-6220
Mailing Address - Fax:
Practice Address - Street 1:920 OLIVER RD
Practice Address - Street 2:SUITE 1600B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-327-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12694R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1547298Medicaid
LA4F604CJ58Medicare PIN
G85575Medicare UPIN