Provider Demographics
NPI:1770737272
Name:ESFAND NAWAB, MD, FACOG, PA
Entity type:Organization
Organization Name:ESFAND NAWAB, MD, FACOG, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESFAND
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-530-4002
Mailing Address - Street 1:5411 W CEDAR LN
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-530-4002
Mailing Address - Fax:301-530-8467
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE 108A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-530-4002
Practice Address - Fax:301-530-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212031300Medicaid
MD212031300Medicaid