Provider Demographics
NPI:1316942022
Name:NASSR, KUSSAY (MD)
Entity type:Individual
Prefix:
First Name:KUSSAY
Middle Name:
Last Name:NASSR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CROWNE POND LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3029
Mailing Address - Country:US
Mailing Address - Phone:267-978-8872
Mailing Address - Fax:
Practice Address - Street 1:12 CROWNE POND LN
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3029
Practice Address - Country:US
Practice Address - Phone:267-978-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4181662084N0400X
LA3386282084N0400X
CT670682084N0400X
NC2023-028262084N0400X, 2084N0008X
FLME1646932084N0400X
VA01012549532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009357880003Medicaid
LA338628OtherLA LICENSE
PA1009357880003Medicaid