Healthcare Provider Details

I. General information

NPI: 1497738934
Provider Name (Legal Business Name): MAHMOOD NASIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MARKET ST
SUNBURY PA
17801-2338
US

IV. Provider business mailing address

512 MARKET ST
SUNBURY PA
17801-2338
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-9878
  • Fax: 570-286-9848
Mailing address:
  • Phone: 570-286-9878
  • Fax: 570-286-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD039921Y
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD039921Y
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD039921Y
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: