Provider Demographics
NPI:1952392441
Name:NAZEERI, MUSADDIQ NADEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSADDIQ
Middle Name:NADEEM
Last Name:NAZEERI
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 1:1023 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6636
Mailing Address - Country:US
Mailing Address - Phone:717-270-9446
Mailing Address - Fax:717-270-5669
Practice Address - Street 1:1023 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6636
Practice Address - Country:US
Practice Address - Phone:717-270-9446
Practice Address - Fax:717-270-5669
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071071L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018420720001Medicaid
H32873Medicare UPIN
PA1842072Medicaid