Basic Information
| Provider Information | |||||||||
| NPI: | 1871814079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASSERHELALI | ||||||||
| FirstName: | NADEREH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 WORCESTER ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011511045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135436820 | ||||||||
| FaxNumber: | 4135437962 | ||||||||
| Practice Location | |||||||||
| Address1: | 819 WORCESTER ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011511045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135436820 | ||||||||
| FaxNumber: | 4135437962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 237859 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110100644A | 05 | MA | MEDICAID |