Provider Demographics
NPI:1982835286
Name:MADHOUN, NISREEN MOUSA (DO)
Entity Type:Individual
Prefix:
First Name:NISREEN
Middle Name:MOUSA
Last Name:MADHOUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MEDICAL CAMPUS DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-7205
Practice Address - Country:US
Practice Address - Phone:215-368-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012912208600000X
TXP9642208600000X
PAOS015659208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery