Provider Demographics
NPI:1487719134
Name:MAHDI, NASSER A (MD)
Entity type:Individual
Prefix:
First Name:NASSER
Middle Name:A
Last Name:MAHDI
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:BOX 7723
Mailing Address - Street 2:
Mailing Address - City:JEDDAH
Mailing Address - State:JEDDAH
Mailing Address - Zip Code:21472
Mailing Address - Country:SA
Mailing Address - Phone:667-7777
Mailing Address - Fax:660-7836
Practice Address - Street 1:BOX 40047
Practice Address - Street 2:
Practice Address - City:JEDDAH
Practice Address - State:JEDDAH
Practice Address - Zip Code:21499
Practice Address - Country:SA
Practice Address - Phone:9662-667-7777
Practice Address - Fax:9662-660-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77148284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital