Healthcare Provider Details

I. General information

NPI: 1740633247
Provider Name (Legal Business Name): FAHAD NASIR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N ELMER AVE APT 10
SAYRE PA
18840-2239
US

IV. Provider business mailing address

30 E APPLE ST STE 3300
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 718-536-8369
  • Fax:
Mailing address:
  • Phone: 937-208-8394
  • Fax: 937-208-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT211776
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.135413
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: