Provider Demographics
NPI:1306050273
Name:NASIR, AMANA N (MD)
Entity type:Individual
Prefix:
First Name:AMANA
Middle Name:N
Last Name:NASIR
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 1:615 S NEW BALLAS RD STE Y-G230
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-5550
Mailing Address - Fax:314-251-5552
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:CHILDREN'S HOSPITAL, GROUND FLOOR, SUITE Y-G224
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-5550
Practice Address - Fax:314-251-5552
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100379422080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008920Medicaid
WV3810008920Medicaid
WVNA6035701Medicare PIN