Provider Demographics
NPI:1043316128
Name:NOUR, PETRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:S
Last Name:NOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:171 OMNI ST
Mailing Address - Street 2:
Mailing Address - City:FOMBELL
Mailing Address - State:PA
Mailing Address - Zip Code:16123-2109
Mailing Address - Country:US
Mailing Address - Phone:724-752-5230
Mailing Address - Fax:724-431-0611
Practice Address - Street 1:103 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1785
Practice Address - Country:US
Practice Address - Phone:724-431-0609
Practice Address - Fax:724-431-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD051352L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF80973Medicare UPIN