Provider Demographics
NPI:1902331267
Name:NIZAM, WASAY (MBBS)
Entity Type:Individual
Prefix:MR
First Name:WASAY
Middle Name:
Last Name:NIZAM
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:HOWARD UNIVERSITY HOSPITAL SURGERY DEPARTMENT RM 4B17
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-1141
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW #1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-11-29
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-11-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program