Provider Demographics
NPI:1093922197
Name:NAZLI, AYESHA (MD)
Entity type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:
Last Name:NAZLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 MELROSE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2716
Mailing Address - Country:US
Mailing Address - Phone:540-362-0360
Mailing Address - Fax:540-362-5590
Practice Address - Street 1:3716 MELROSE AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2716
Practice Address - Country:US
Practice Address - Phone:540-362-0360
Practice Address - Fax:540-362-5590
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22742207Q00000X
VA0101239912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009211Medicaid
WV000056944UOtherHUMANA
WV001969694OtherMOUNTAIN STATE BLUE CROSS
WVP00401503OtherRAILROAD MEDICARE PIN
WV3810009211Medicaid
VA017007K07Medicare PIN