Healthcare Provider Details

I. General information

NPI: 1912465378
Provider Name (Legal Business Name): SAJID QAISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 CEDAR ST
ROCKLEDGE FL
32955-3133
US

IV. Provider business mailing address

1750 CEDAR ST
ROCKLEDGE FL
32955-3133
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-1981
  • Fax: 321-633-1981
Mailing address:
  • Phone: 321-633-1981
  • Fax: 321-633-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME76234
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME76234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: