Healthcare Provider Details

I. General information

NPI: 1205275914
Provider Name (Legal Business Name): NASIR NAWAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4687
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1212
  • Fax: 352-371-4650
Mailing address:
  • Phone: 610-447-2000
  • Fax: 610-447-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT203245
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME145044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: