Provider Demographics
NPI:1285817049
Name:NASR, TALA RAMZI (MD)
Entity Type:Individual
Prefix:
First Name:TALA
Middle Name:RAMZI
Last Name:NASR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-277-4164
Mailing Address - Fax:602-266-3481
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:SUITE 375
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-277-4164
Practice Address - Fax:602-266-3481
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0594812080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0549481Medicaid