MEDICARE: NABILA AL-BARGHOUTHY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9801	MN

General Provider Information

NPI Number	:	1730126889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NABILA AL-BARGHOUTHY PA-C

Provider Business Mailing Address
First Line	:	206 BENEDICT AVE
Second Line	:	THORNWOOD
City	:	THORNWOOD
State	:	NY
Zip	:	10594-1204
Country	:	US
Telephone Number	:	612-532-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 BENEDICT AVE
Second Line	:
City	:	THORNWOOD
State	:	NY
Zip	:	10594-1204
Country	:	US
Telephone Number	:	612-532-3131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	01/22/2008

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