Healthcare Provider Details

I. General information

NPI: 1437444585
Provider Name (Legal Business Name): NASRIDEEN MOHAMMED NOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17TH & CHEW STREET CHILDREN'S CLINIC
ALLENTOWN PA
18105-7017
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 610-969-4300
  • Fax: 610-969-4332
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01070202A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD452775
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: