Healthcare Provider Details

I. General information

NPI: 1346349099
Provider Name (Legal Business Name): RALPH E NAZZARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W CENTRAL AVE
TITUSVILLE PA
16354-1724
US

IV. Provider business mailing address

218 W SPRUCE ST
TITUSVILLE PA
16354-2516
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-3400
  • Fax: 814-827-3556
Mailing address:
  • Phone: 814-827-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD018974E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: