Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS019318L | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS019318L | PA |
NPI | 1497700272 |
---|---|
Provider Name | Nabil A Abaza |
First Address | Philadelphia, PA 19102-1321 |
Second Address | Philadelphia, PA 19107-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 29/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000767939 | (05) | PA |
T29768 | (02) | PA |