Basic Information
| Provider Information | |||||||||
| NPI: | 1215109509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASIR | ||||||||
| FirstName: | AYESHA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 MINTON VALLEY LN | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275199105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198658000 | ||||||||
| FaxNumber: | 9198658020 | ||||||||
| Practice Location | |||||||||
| Address1: | 12341 STRICKLAND RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276131273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198658000 | ||||||||
| FaxNumber: | 9198658020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 07/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 139328 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 2010-01420 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AC3193226-5008 | 01 | NC | DEA | OTHER |