Provider Demographics
NPI:1992763510
Name:NASSERY, MOHAMMAD D (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:D
Last Name:NASSERY
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 1:59 TREELINE DR
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1763
Mailing Address - Country:US
Mailing Address - Phone:508-790-5777
Mailing Address - Fax:
Practice Address - Street 1:407 NORTH ST
Practice Address - Street 2:ARIANA PEDIATRIC NEUROLOGY
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5121
Practice Address - Country:US
Practice Address - Phone:508-790-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2672549OtherAETNA
MA7502746OtherUNITED HEALTHCARE
MAJ22677OtherBCBS
MA5689943OtherCIGNA
MA0185574Medicaid
MA158445OtherTUFTS