Basic Information
Provider Information | |||||||||
NPI: | 1427360577 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NASSAR | ||||||||
FirstName: | RULA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2604 CRESTLINE CT. | ||||||||
Address2: |   | ||||||||
City: | GLEN MILLS | ||||||||
State: | PA | ||||||||
PostalCode: | 19342 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2155902437 | ||||||||
FaxNumber: | 2155902768 | ||||||||
Practice Location | |||||||||
Address1: | 4755 OGLETOWN - STANTON RD | ||||||||
Address2: | MAP SUITE 217 | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 19713 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9082407611 | ||||||||
FaxNumber: | 2155902768 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/06/2010 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT197111 | PA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2080N0001X | C1-0012043 | DE | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.