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General NPI Number Information
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NPI Number | 1609261734
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Entity Type | Individual
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Provider Name | NIZAR BOU DIAB MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 500 J CLYDE MORRIS BLVD SUITE 500
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City | NEWPORT NEWS
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State | VA
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Zip | 23601
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Country | US
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Telephone | 757-873-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601
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Country | US
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Telephone | 757-316-5800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101283449
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35.146429
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License Number State | OH
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