Healthcare Provider Details

I. General information

NPI: 1700650199
Provider Name (Legal Business Name): NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 05/14/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 DOBBIN RD STE A
COLUMBIA MD
21045-5804
US

IV. Provider business mailing address

700 GEIPE RD
CATONSVILLE MD
21228-4147
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-0661
  • Fax: 410-744-8036
Mailing address:
  • Phone: 410-744-0661
  • Fax: 410-744-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA MIHM
Title or Position: OFFICE MANAGER/CREDENTIALING SPEC
Credential:
Phone: 410-744-0661