Individual provider Active NPI

Maryam Nisa

  • Family Nurse Practitioner
  • Towson, MD
National Provider Identifier
1992284095
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R196002 Issued in MD
Practice address
6701 N Charles St
Towson, MD 21204-6808
Phone
(443) 370-3084
NPI assigned
Aug 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R196002 MD Primary

Addresses

Primary practice location

6701 N Charles St
Towson, MD 21204-6808

Mailing address

6701 N Charles St
Towson, MD 21204-6808
Phone (443) 370-3084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181114003226 MD Practitioner - Nurse Practitioner 3779837513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Baltimore Medical CenterGroup PAC ID 1759276975, 350 clinicians

Practice addresses (Care Compare)

6565 N Charles St
512 GBMC Gastro Ppe
Baltimore, MD 21204-6826
Phone (443) 849-3400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Medical Center, Inc. CurrentSince Oct 22, 2018 Accepting new patients
Greater Baltimore Medical Center, Inc Family Current Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Oct 22, 2018 Accepting new patients

Locations

6565 N Charles St
Ste 512
Towson, MD 21204
Phone (410) 583-0300

6569 N Charles St
Ste 505
Towson, MD 21204
Phone (443) 849-2196

6569 N Charles St
Ste 307
Towson, MD 21204
Phone (443) 849-2767

6701 N Charles St
Towson, MD 21204
Phone (443) 849-2000

Interoperability endpoints

  • Direct secure messaging: mnisa47835@gbmcdirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533772800000",
    "number": "1992284095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046808",
            "telephone_number": "443-370-3084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046808",
            "telephone_number": "443-370-3084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISA",
        "first_name": "MARYAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R196002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

Verify at the official NPI Registry.