Healthcare Provider Details

I. General information

NPI: 1639502313
Provider Name (Legal Business Name): NASSERI CLINIC OF ARTHRITIC & RHEUMATIC DISEASES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3168 BRAVERTON ST STE 330
EDGEWATER MD
21037-2680
US

IV. Provider business mailing address

700 GEIPE RD ST. 200
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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