Basic Information
| Provider Information | |||||||||
| NPI: | 1225100910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASOODI | ||||||||
| FirstName: | NASSEER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 LAKE SUMTER LNDG | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321622699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526748905 | ||||||||
| FaxNumber: | 3526748905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 SANTA BARBARA BLVD | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321596820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526741740 | ||||||||
| FaxNumber: | 3526748940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | ME90150 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 48085Y | 01 | FL | PTAN | OTHER | MEDICAID | 05 | FL | MEDICAID | BCBS PROVIDER NUMBER | 01 | FL | 48085 | OTHER | AVMED PROVIDER NUMBE | 01 | FL | 294187 | OTHER |