Provider Demographics
NPI:1689815888
Name:MOIDUDDIN, NASSER (MD)
Entity type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:MOIDUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NASSER
Other - Middle Name:JUNAID
Other - Last Name:MOIDUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-502-2037
Practice Address - Fax:410-955-0737
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010874072080P0202X, 208000000X
WV272372080P0202X
MDD01022112080P0202X
NMMD2021-01012080P0202X, 207RA0002X
TXU8223207RA0002X
CAA109143208000000X, 207RA0002X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05930OtherPARAMOUNT
OH3007356Medicaid
OH000000645226OtherANTHEM
OH9766413OtherAETNA
OH3007356OtherBCMH
OH3007356Medicaid