Basic Information
| Provider Information | |||||||||
| NPI: | 1730210303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASIR | ||||||||
| FirstName: | AMIR | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MORNINGSIDE DR N BLDG B | ||||||||
| Address2: | |||||||||
| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068803850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037728063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265061200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8559882273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | M-14559 | ID | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 051774 | CT | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1730210303 | 05 | ID | MEDICAID | 1730210303 | 05 | CT | MEDICAID |