Provider Demographics
NPI:1881662286
Name:ATWEH, NABIL A (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:A
Last Name:ATWEH
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:PO BOX 415126
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:203-384-3975
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2811
Practice Address - Country:US
Practice Address - Phone:203-384-3394
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031404208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001314046Medicaid
CT001314046Medicaid
CT020001049Medicare ID - Type Unspecified