Provider Demographics
NPI:1215292594
Name:YADAK, NOUR MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:MOHAMMAD
Last Name:YADAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603283
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3283
Mailing Address - Country:US
Mailing Address - Phone:866-789-4893
Mailing Address - Fax:678-459-0526
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-7182
Practice Address - Fax:901-276-5474
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN57458207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology