Organization
BOUSAMRA MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE R BOUSAMRA MD (OWNER)
(724) 374-5920
Entity
Organization
Contact information
Practice address
1111 LOWRY AVE BLDG A, JEANNETTE, PA 15644-3063
(724) 374-5920
(724) 374-5873
Mailing address
1111 LOWRY AVE BLDG A, JEANNETTE, PA 15644-3063
(724) 374-5920
(724) 374-5873
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD067949L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017515030010
—
PA
Enumeration date
01/13/2015
Last updated
01/13/2015
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