Provider Demographics
NPI:1851559231
Name:ELSACCAR, OSSAMA ALY (MT)
Entity Type:Individual
Prefix:
First Name:OSSAMA
Middle Name:ALY
Last Name:ELSACCAR
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 6TH AVE
Mailing Address - Street 2:PO BOX 16052
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1426
Mailing Address - Country:US
Mailing Address - Phone:610-988-5202
Mailing Address - Fax:
Practice Address - Street 1:300 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1426
Practice Address - Country:US
Practice Address - Phone:610-988-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191762207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT191762OtherSTATE LICENSE