Provider Demographics
NPI:1053389890
Name:NASSAR, FAWAZ (MD)
Entity type:Individual
Prefix:
First Name:FAWAZ
Middle Name:
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FAWAZ
Other - Middle Name:
Other - Last Name:NASSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:155 SAND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2027
Mailing Address - Country:US
Mailing Address - Phone:570-708-1996
Mailing Address - Fax:570-708-1996
Practice Address - Street 1:1090 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1446
Practice Address - Country:US
Practice Address - Phone:570-459-1485
Practice Address - Fax:570-459-6354
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025370Medicare ID - Type Unspecified
H55302Medicare UPIN