Provider Demographics
NPI:1679618136
Name:REZA A NAINI MD PA
Entity type:Organization
Organization Name:REZA A NAINI MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:AGHAZADEH
Authorized Official - Last Name:NAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-3787
Mailing Address - Street 1:110 HOSPITAL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4019
Mailing Address - Country:US
Mailing Address - Phone:410-535-3787
Mailing Address - Fax:410-257-3866
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-535-3787
Practice Address - Fax:410-257-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210241200Medicaid
6673OtherBLUE SHIELD NCA
MD6378REOtherBLUE SHIELD
MD6378REOtherBLUE SHIELD