Healthcare Provider Details

I. General information

NPI: 1811228976
Provider Name (Legal Business Name): NASSER MAJID SHIRAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 08/01/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-3835
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-3835
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4888
  • Fax: 860-679-1153
Mailing address:
  • Phone: 860-679-4888
  • Fax: 860-679-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51133
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number051133
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: