Provider Demographics
NPI:1407230279
Name:NASSAR, MO'ATH (MD)
Entity type:Individual
Prefix:DR
First Name:MO'ATH
Middle Name:
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MO'ATH
Other - Middle Name:
Other - Last Name:NASSAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2231 CAREW ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4713
Practice Address - Country:US
Practice Address - Phone:260-266-7856
Practice Address - Fax:260-266-5279
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066718207R00000X
KY55240207RP1001X
IN01095956A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine