Provider Demographics
NPI:1114911518
Name:BISHARA, NADER (MD)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:BISHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-245-1237
Mailing Address - Fax:256-249-5040
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-245-1237
Practice Address - Fax:256-249-5040
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AL22103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL22103OtherALABAMA STATE LICENSE NO.
AL52992100Medicaid
ALBB6351073OtherDEA
AL52992100Medicaid