Healthcare Provider Details

I. General information

NPI: 1982910949
Provider Name (Legal Business Name): RAFIK A NASR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 TOWN SQUARE DR
LUSBY MD
20657-6534
US

IV. Provider business mailing address

PO BOX 269
LUSBY MD
20657-0269
US

V. Phone/Fax

Practice location:
  • Phone: 410-326-8100
  • Fax: 410-414-5216
Mailing address:
  • Phone: 410-326-8100
  • Fax: 410-414-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberD0037588
License Number StateMD

VIII. Authorized Official

Name: RAFIK ABOUL-NASR
Title or Position: PHYSICIAN
Credential: MD
Phone: 410-326-8100