Healthcare Provider Details

I. General information

NPI: 1134570633
Provider Name (Legal Business Name): USAMA BIN NASIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3060
US

IV. Provider business mailing address

711 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3060
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-8756
  • Fax:
Mailing address:
  • Phone: 860-242-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number279313
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number279313
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number71049
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: