Provider Demographics
NPI:1154355345
Name:KANGO, NASREEN (MD)
Entity type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:
Last Name:KANGO
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 1:409 NATURE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7767
Mailing Address - Country:US
Mailing Address - Phone:301-270-7606
Mailing Address - Fax:
Practice Address - Street 1:7701 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7724
Practice Address - Country:US
Practice Address - Phone:301-270-7606
Practice Address - Fax:301-260-7608
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056147207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414960200Medicaid
MDH56913Medicare UPIN
DCG02494N01Medicare PIN