Basic Information
| Provider Information | |||||||||
| NPI: | 1972706091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABOSAMRA | ||||||||
| FirstName: | WASSIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 SOMERSET AVE | ||||||||
| Address2: | |||||||||
| City: | WINDBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159631329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144671640 | ||||||||
| FaxNumber: | 8144671624 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 EAST 21ST STREET | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102621519 | ||||||||
| FaxNumber: | 6102627125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD434855 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007698380002 | 05 | PA | MEDICAID | 1007698380001 | 05 | PA | MEDICAID |