Provider Demographics
NPI:1477505634
Name:NADIM, YASSER A (MD)
Entity Type:Individual
Prefix:DR
First Name:YASSER
Middle Name:A
Last Name:NADIM
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 1:118 TRADEPARK DR
Mailing Address - Street 2:ST B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3427
Mailing Address - Country:US
Mailing Address - Phone:606-679-7464
Mailing Address - Fax:606-678-8586
Practice Address - Street 1:118 TRADEPARK DR
Practice Address - Street 2:STE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3427
Practice Address - Country:US
Practice Address - Phone:606-679-7464
Practice Address - Fax:606-678-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34018207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000174415OtherBC/BS
KY64340185Medicaid
KY000000174415OtherBC/BS
KY64340185Medicaid