Provider Demographics
NPI:1407230279
Name:NASSAR, MO'ATH (MD)
Entity Type:Individual
Prefix:DR
First Name:MO'ATH
Middle Name:
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MO'ATH
Other - Middle Name:
Other - Last Name:NASSAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5000 KY ROUTE 321 STE 3141
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9113
Mailing Address - Country:US
Mailing Address - Phone:606-889-6370
Mailing Address - Fax:606-263-5654
Practice Address - Street 1:5000 KY ROUTE 321 STE 3141
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6370
Practice Address - Fax:606-263-5654
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066718207R00000X
KY55240207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine