Healthcare Provider Details

I. General information

NPI: 1588800981
Provider Name (Legal Business Name): JOHN YACOUB NASR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

PO BOX 9156
MORGANTOWN WV
26506-9156
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-4123
  • Fax: 304-285-7126
Mailing address:
  • Phone: 304-293-4123
  • Fax: 304-285-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD444706
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD444706
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26159
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: