Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 230421 | MA |
N | 111NI0900X | Internist | 230421 | MA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD442547 | PA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD442547 | PA |
NPI | 1255492963 |
---|---|
Provider Name | Tareck O Nossuli |
First Address | Lancaster, PA 17603-2964 |
Second Address | Lancaster, PA 17603-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026033660001 | (05) | PA |