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General NPI Number Information
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NPI Number | 1053444018
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Entity Type | Organization
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Legal Business Name | ANWAR NAKKOUL MD, PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 1023 CENTRE ST
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City | ASHLAND
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State | PA
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Zip | 17921-1204
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Country | US
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Telephone | 570-875-3665
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Fax | 570-875-2012
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Provider Business Mailing Address
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Address Line | 1023 CENTRE ST
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City | ASHLAND
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State | PA
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Zip | 17921-1204
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Country | US
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Telephone | 570-875-3665
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Fax | 570-875-2012
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NICOLE BLASE
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Credential |
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Telephone | 570-875-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD059146L
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License Number State | PA
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