Provider Demographics
NPI:1154523959
Name:MAKHSIDA, NAWRAS (MD)
Entity type:Individual
Prefix:
First Name:NAWRAS
Middle Name:
Last Name:MAKHSIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2025
Mailing Address - Country:US
Mailing Address - Phone:973-343-7040
Mailing Address - Fax:973-718-4881
Practice Address - Street 1:715 ROUTE 10
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2025
Practice Address - Country:US
Practice Address - Phone:973-343-7040
Practice Address - Fax:973-718-4881
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11801900207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0943592Medicaid
MO152800161Medicare PIN
MO152810099Medicare PIN