Basic Information
| Provider Information | |||||||||
| NPI: | 1740248889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASIM | ||||||||
| FirstName: | SUHAIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20452 | ||||||||
| Address2: | PSMG-CRED | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432200452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422406 | ||||||||
| FaxNumber: | 6144422410 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DRIVE, | ||||||||
| Address2: | DEPT OF PATHOLOGY | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883488 | ||||||||
| FaxNumber: | 7573883799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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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 | 207ZP0007X | 0101056075 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | 207ZP0102X | 0101056075 | VA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 1740248889 | 05 | VA | MEDICAID | 790569T | 05 | NC | MEDICAID |