Healthcare Provider Details

I. General information

NPI: 1366049876
Provider Name (Legal Business Name): FAHAD NAYIM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

1017 FAIRWINDS CT
SALISBURY MD
21801-7450
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-6339
  • Fax:
Mailing address:
  • Phone: 443-944-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: FAHAD NAYIM
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 443-944-6570