Healthcare Provider Details

I. General information

NPI: 1528835493
Provider Name (Legal Business Name): MAYSE MOHAMAD NASSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

315 TRENT DR # 27710
DURHAM NC
27710-3038
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-9093
  • Fax: 919-668-4859
Mailing address:
  • Phone: 919-638-9093
  • Fax: 919-668-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberRTL23-1252
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: