MEDICARE: SAMMY NASSRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RN0300X	Nephrology Physician	36988	SC

General Provider Information

NPI Number	:	1457764912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMMY NASSRI M.D.

Provider Business Mailing Address
First Line	:	3031 SAINT MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-1443
Country	:	US
Telephone Number	:	803-531-2677
Fax Number	:	803-531-6137

Provider Business Practice Location Address
First Line	:	3031 SAINT MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-1443
Country	:	US
Telephone Number	:	803-531-2677
Fax Number	:	803-531-6137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	02/28/2023

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