Healthcare Provider Details

I. General information

NPI: 1972623445
Provider Name (Legal Business Name): JEFFREY ALLEN NASER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N WAYNE AVE SUITE 300
WAYNE PA
19087-3542
US

IV. Provider business mailing address

2589 RADCLIFFE RD
BROOMALL PA
19008-2304
US

V. Phone/Fax

Practice location:
  • Phone: 610-975-9435
  • Fax: 610-975-9851
Mailing address:
  • Phone: 610-325-9713
  • Fax: 610-975-9851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD050700L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: