MEDICARE: DR. LINA NASR-ANAISSIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-120321	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386752947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINA NASR-ANAISSIE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-5507
Fax Number	:

Provider Business Practice Location Address
First Line	:	6645 PRINCETON GLENDALE RD
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-7547
Country	:	US
Telephone Number	:	513-829-2883
Fax Number	:	513-829-6346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	03/27/2019

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