Healthcare Provider Details

I. General information

NPI: 1780720409
Provider Name (Legal Business Name): FADI NUKTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FADI ABOU-NUKTA MD

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LINCOLN ST DEPARTMENT OF SURGERY/PLASTIC SURGERY
WORCESTER MA
01605-2138
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-5958
  • Fax: 508-334-5752
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number232294
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: