Provider Demographics
NPI:1740227024
Name:NAHID ISLAM INCORPORATION
Entity type:Organization
Organization Name:NAHID ISLAM INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-699-0580
Mailing Address - Street 1:3100 FORSYTHE AVE
Mailing Address - Street 2:SUITE NB
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3014
Mailing Address - Country:US
Mailing Address - Phone:318-699-0580
Mailing Address - Fax:318-699-0506
Practice Address - Street 1:3100 FORSYTHE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3014
Practice Address - Country:US
Practice Address - Phone:318-699-0580
Practice Address - Fax:318-699-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12694R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty