Provider Demographics
NPI:1538568365
Name:ADIMI, NASIM (PA)
Entity type:Individual
Prefix:
First Name:NASIM
Middle Name:
Last Name:ADIMI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W NINTH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4546
Mailing Address - Country:US
Mailing Address - Phone:301-695-6800
Mailing Address - Fax:301-695-6891
Practice Address - Street 1:310 W NINTH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4546
Practice Address - Country:US
Practice Address - Phone:301-695-6800
Practice Address - Fax:301-695-6891
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC07030207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1962508887Medicaid