Provider Demographics
NPI:1316924897
Name:NASSERI, AFSHIN (MD)
Entity type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:NASSERI
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 1:300 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-737-1188
Mailing Address - Fax:401-737-5613
Practice Address - Street 1:300 TOLLGATE ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-1188
Practice Address - Fax:401-737-5613
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10174207R00000X
MA216396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAN49563Medicaid
RIAN49563Medicaid
H11798Medicare UPIN
MAA37852Medicare ID - Type Unspecified