Provider Demographics
NPI:1528060944
Name:NAWAB, ESFAND (MD)
Entity type:Individual
Prefix:
First Name:ESFAND
Middle Name:
Last Name:NAWAB
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 1:5411 W CEDAR LN
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-530-4002
Mailing Address - Fax:
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE 108A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-530-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212031300Medicaid
MDC62256Medicare UPIN