Provider Demographics
NPI:1427291541
Name:ELSWERKY, NASER
Entity type:Individual
Prefix:
First Name:NASER
Middle Name:
Last Name:ELSWERKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 BRANDONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2512
Mailing Address - Country:US
Mailing Address - Phone:812-222-0688
Mailing Address - Fax:
Practice Address - Street 1:6124 BRANDONWOOD LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2512
Practice Address - Country:US
Practice Address - Phone:812-222-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200885320AMedicaid