| Nasser Moukaddem, M.d., P.a. | |
|
4226 Central Ave St Petersburg FL 33711-1140 | |
| (727) 321-3915 | |
| (727) 328-0975 |
| Full Name | Nasser Moukaddem, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4226 Central Ave, St Petersburg, Florida |
| Authorized Official Name and Position | Nasser Moukaddem (PRESIDENT) |
| Authorized Official Contact | 7273213915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nasser Moukaddem, M.d., P.a. 4226 Central Ave St Petersburg FL 33711-1140 Ph: (727) 321-3915 | Nasser Moukaddem, M.d., P.a. 4226 Central Ave St Petersburg FL 33711-1140 Ph: (727) 321-3915 |
| NPI Number | 1831220235 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 12/04/2013 |
| Medicare PECOS PAC ID | 6002097748 |
|---|---|
| Medicare Enrollment ID | O20110301000029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831220235 | NPI | - | NPPES |
| 260638100 | Medicaid | FL | |
| 110189691 | Other | FL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME71447 (Florida) | Primary |
| Provider Name | Nasser Moukaddem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124008883 PECOS PAC ID: 1658274683 Enrollment ID: I20040721000396 |
| Provider Name | Marina Barkov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790765469 PECOS PAC ID: 9537340278 Enrollment ID: I20111006000552 |
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