Provider Demographics
NPI:1174575583
Name:NACHAR, OUSSAMA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:OUSSAMA
Middle Name:
Last Name:NACHAR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SAN ROMAN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7532
Mailing Address - Country:US
Mailing Address - Phone:956-362-7553
Mailing Address - Fax:
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5503
Practice Address - Country:US
Practice Address - Phone:956-661-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.14005R207U00000X
TXK8800207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1188042Medicaid
LA4A199Medicare ID - Type Unspecified
H28928Medicare UPIN