Provider Demographics
NPI:1669541009
Name:NASSAR, SAM J (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:J
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SOUHEIL
Other - Middle Name:JAMAL
Other - Last Name:NASSAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1295
Mailing Address - Country:US
Mailing Address - Phone:304-323-4329
Mailing Address - Fax:304-323-4333
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:304-234-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068995207ZP0102X
PAMD057961L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050711Medicaid
WV0104181000Medicaid
PA1028768910001Medicaid
220023024OtherRAILROAD MEDICARE
PA1028768910001Medicaid
WV0104181000Medicaid
OH4301171Medicare PIN
220023024OtherRAILROAD MEDICARE
WV4281541Medicare PIN