Healthcare Provider Details

I. General information

NPI: 1154955862
Provider Name (Legal Business Name): NARDINE ASSAAD, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DR STE 407
TOWSON MD
21204-7536
US

IV. Provider business mailing address

120 SISTER PIERRE DR STE 407
TOWSON MD
21204-7536
US

V. Phone/Fax

Practice location:
  • Phone: 410-769-8801
  • Fax: 410-769-8803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NARDINE ASSAAD
Title or Position: OWNER
Credential: MD
Phone: 410-769-8801