Provider Demographics
NPI:1306595327
Name:PERVEEN, NUSRAT (MD)
Entity type:Individual
Prefix:
First Name:NUSRAT
Middle Name:
Last Name:PERVEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NUSRAT
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1033 RIVERBANK WAY
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6H 6X1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 RIVERBANK WAY
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L6H 6X1
Practice Address - Country:CA
Practice Address - Phone:905-582-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315180207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology