Healthcare Provider Details

I. General information

NPI: 1275513442
Provider Name (Legal Business Name): NADEEM ANIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE.
PROVIDENCE RI
02906
US

IV. Provider business mailing address

PO BOX 3238
BOSTON MA
02241
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2104
  • Fax: 401-793-4047
Mailing address:
  • Phone: 866-689-8862
  • Fax: 207-347-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number234029
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13396
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD427665
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD427665
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: