Provider Demographics
NPI:1871587980
Name:NAZAR, JOSE ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ENRIQUE
Last Name:NAZAR
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 1:71 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-265-6300
Mailing Address - Fax:570-268-2807
Practice Address - Street 1:71 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9702
Practice Address - Country:US
Practice Address - Phone:570-265-6300
Practice Address - Fax:570-268-2807
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035679E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001121842Medicaid
PA516900Medicare PIN
PA001121842Medicaid