Healthcare Provider Details

I. General information

NPI: 1255409082
Provider Name (Legal Business Name): TRI-STATE HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N BRIDGE ST
ELKTON MD
21921-5326
US

IV. Provider business mailing address

107 N BRIDGE ST
ELKTON MD
21921-5326
US

V. Phone/Fax

Practice location:
  • Phone: 410-392-6408
  • Fax: 410-392-6409
Mailing address:
  • Phone: 410-392-6408
  • Fax: 410-392-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMED A NIAZ
Title or Position: OWNER
Credential: M.D.
Phone: 410-392-6408