Healthcare Provider Details

I. General information

NPI: 1699876235
Provider Name (Legal Business Name): NAHID MAZAREI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E SWAN CREEK RD
FT WASHINGTON MD
20744-5250
US

IV. Provider business mailing address

10403 HOSPITAL DR SUITE G4
CLINTON MD
20735-3134
US

V. Phone/Fax

Practice location:
  • Phone: 301-203-3345
  • Fax: 301-203-2186
Mailing address:
  • Phone: 301-856-3019
  • Fax: 301-856-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0060499
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: