Provider Demographics
NPI:1104948082
Name:MUSADDIQ NAZEERI, MD, PC
Entity type:Organization
Organization Name:MUSADDIQ NAZEERI, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:NAZEERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-9446
Mailing Address - Street 1:1023 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6636
Mailing Address - Country:US
Mailing Address - Phone:717-270-9446
Mailing Address - Fax:717-270-5669
Practice Address - Street 1:1023 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6636
Practice Address - Country:US
Practice Address - Phone:717-270-9446
Practice Address - Fax:717-270-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071071-L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038504970001Medicaid
PA1842072Medicaid
PA046245Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER