Basic Information
| Provider Information | |||||||||
| NPI: | 1427229202 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NASIM GHAFFAR, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 NASHUA RD | ||||||||
| Address2: | |||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018261929 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 NASHUA RD | ||||||||
| Address2: | |||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018261929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789574474 | ||||||||
| FaxNumber: | 9789574475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | GHAFFAR | ||||||||
| AuthorizedOfficialFirstName: | NASIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9789574474 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 46370 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | J01040 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER | 2091232 | 05 | MA | MEDICAID |