Provider Demographics
NPI:1730210303
Name:NASIR, AMIR R (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:R
Last Name:NASIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 NEWTOWN RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-830-4700
Mailing Address - Fax:203-730-4162
Practice Address - Street 1:107 NEWTOWN RD STE 2C
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4146
Practice Address - Country:US
Practice Address - Phone:203-830-4700
Practice Address - Fax:203-730-4162
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14559208200000X
CT051774208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1730210303Medicaid
CT1730210303Medicaid