Provider Demographics
NPI:1558436436
Name:OSWALD, NADINE KFOURY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:KFOURY
Last Name:OSWALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 WOODFORK RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3033
Mailing Address - Country:US
Mailing Address - Phone:410-252-8962
Mailing Address - Fax:
Practice Address - Street 1:617 STEMMERS RUN RD STE F
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3361
Practice Address - Country:US
Practice Address - Phone:410-780-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000614363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP48740Medicare UPIN