Basic Information
| Provider Information | |||||||||
| NPI: | 1356877849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAZEM | ||||||||
| FirstName: | PAYAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2507 N POINT RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212221605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102846650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | YORK HOSPITAL | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512655 | ||||||||
| FaxNumber: | 7178513565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2017 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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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 | 122300000X | 16472 | MD | Y | Dental Providers | Dentist |
No ID Information.