Provider Demographics
NPI:1700650199
Name:NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Entity type:Organization
Organization Name:NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CREDENTIALING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-0661
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-744-0661
Mailing Address - Fax:410-744-8036
Practice Address - Street 1:6100 DOBBIN RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5804
Practice Address - Country:US
Practice Address - Phone:410-744-0661
Practice Address - Fax:410-744-8036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty