Individual
ILYA M NASRALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-4206
(215) 615-8054
Mailing address
3400 SPRUCE STREET, 1 SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-8054
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
MD439819
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD439819
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102472676-0001
—
PA
Enumeration date
01/09/2007
Last updated
08/19/2015
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