Basic Information
Provider Information
NPI: 1124669213
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AISSAOUI
FirstName: NADIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 858
Address2: MC A410
City: HERSHEY
State: PA
PostalCode: 170330858
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber: 7175314077
Practice Location
Address1: 500 UNIVERSITY DRIVE
Address2:  
City: HERSHEY
State: PA
PostalCode: 170330858
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber: 7175314077
Other Information
ProviderEnumerationDate: 10/01/2019
LastUpdateDate: 10/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XLT000820PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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