Healthcare Provider Details

I. General information

NPI: 1518908458
Provider Name (Legal Business Name): JEANETTE T NAZARIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN HOWARD COUNTY GENERAL HOSPITAL
COLUMBIA MD
21044-2912
US

IV. Provider business mailing address

PO BOX 64075
BALTIMORE MD
21264-4075
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0056399
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: