Provider Demographics
NPI:1316911092
Name:NISAR, ASIF (MD)
Entity type:Individual
Prefix:
First Name:ASIF
Middle Name:
Last Name:NISAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHAUDHRY
Other - Middle Name:ASIF
Other - Last Name:NISAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 18TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5874
Mailing Address - Country:US
Mailing Address - Phone:337-439-5369
Mailing Address - Fax:337-436-9998
Practice Address - Street 1:300 18TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5874
Practice Address - Country:US
Practice Address - Phone:337-439-5369
Practice Address - Fax:337-436-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72826207R00000X, 207RN0300X
LAMD.203470207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.203470OtherMEDICAL LICENSE
NJ9116306Medicaid
NJ9116306Medicaid
NJ050915P6SMedicare PIN