Healthcare Provider Details

I. General information

NPI: 1275564965
Provider Name (Legal Business Name): MOHAMMAD SAID NASSRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1443
US

IV. Provider business mailing address

3031 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1443
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-2677
  • Fax: 803-531-6137
Mailing address:
  • Phone: 803-531-2677
  • Fax: 803-531-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9697
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number09697
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: