Healthcare Provider Details

I. General information

NPI: 1548250913
Provider Name (Legal Business Name): JAY P NASSAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RUTHERFORD RD STE 101
HARRISBURG PA
17109-4540
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-545-5256
  • Fax: 717-545-5259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD049745L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: