Provider Demographics
NPI:1316983554
Name:NASRALLAH, NASEEM HANI (MD)
Entity type:Individual
Prefix:
First Name:NASEEM
Middle Name:HANI
Last Name:NASRALLAH
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0729
Mailing Address - Country:US
Mailing Address - Phone:910-259-2161
Mailing Address - Fax:910-259-7870
Practice Address - Street 1:407 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-0729
Practice Address - Country:US
Practice Address - Phone:910-259-2161
Practice Address - Fax:910-259-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19763208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1738874OtherUHC
41658OtherMIDCOAST
561667413OtherCIGNA
61886OtherBCBS
NC7961886Medicaid
561667413OtherCIGNA
61886OtherBCBS