Provider Demographics
NPI:1104803295
Name:NASSER, TONY K (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:K
Last Name:NASSER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2723 S 7TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-232-8164
Mailing Address - Fax:812-234-6391
Practice Address - Street 1:2723 S 7TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3558
Practice Address - Country:US
Practice Address - Phone:812-232-8164
Practice Address - Fax:812-234-6391
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01041492A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200089070Medicaid
INM400015068Medicare PIN
INF54035Medicare UPIN
INF54035Medicare UPIN