Healthcare Provider Details

I. General information

NPI: 1669425120
Provider Name (Legal Business Name): QAYYUM NAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 PULASKI HWY
BEAR DE
19701-1708
US

IV. Provider business mailing address

1993 PULASKI HWY
BEAR DE
19701-1708
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-3100
  • Fax: 667-215-0937
Mailing address:
  • Phone: 302-838-3100
  • Fax: 667-215-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberD64083
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00039324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: