Provider Demographics
NPI:1588830590
Name:NAKIB, EVAN Z (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:Z
Last Name:NAKIB
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 1:1099 S TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3247
Mailing Address - Country:US
Mailing Address - Phone:570-602-2400
Mailing Address - Fax:
Practice Address - Street 1:1099 S TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3247
Practice Address - Country:US
Practice Address - Phone:570-602-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD465794207Q00000X
TXP2741207Q00000X
LA201711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071315Medicaid
LA1071315Medicaid