Healthcare Provider Details

I. General information

NPI: 1043257256
Provider Name (Legal Business Name): MIRZA M. NUSAIREE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 CROFTON CTR STE 5
CROFTON MD
21114-1389
US

IV. Provider business mailing address

1667 CROFTON CTR STE 5
CROFTON MD
21114-1389
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-2700
  • Fax: 410-721-8874
Mailing address:
  • Phone: 410-721-2700
  • Fax: 410-721-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0040519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: