Provider Demographics
NPI:1962433565
Name:PALMETTO NEPHROLOGY PA
Entity type:Organization
Organization Name:PALMETTO NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:NASSRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-531-2677
Mailing Address - Street 1:3031 SAINT MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1443
Mailing Address - Country:US
Mailing Address - Phone:803-531-2677
Mailing Address - Fax:803-531-6137
Practice Address - Street 1:3031 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1443
Practice Address - Country:US
Practice Address - Phone:803-531-2677
Practice Address - Fax:803-531-6137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3407Medicaid
SC7350Medicare ID - Type Unspecified