=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003842428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M.E. NURBHAI, M.D,, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 E 2ND ST
-----------------------------------------------------
City | COUDERSPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16915-8161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-274-7761
-----------------------------------------------------
Fax | 814-274-7753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 E 2ND ST
-----------------------------------------------------
City | COUDERSPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16915-8161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-274-7761
-----------------------------------------------------
Fax | 814-274-7753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OTOLARYNGOLIST
-----------------------------------------------------
Name | MURTAZA E NURBHAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 814-274-7761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | MD019973E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------