1285615245 NPI number — HESHAM H EL GAMAL M.D.

Table of content: HESHAM H EL GAMAL M.D. (NPI 1285615245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285615245 NPI number — HESHAM H EL GAMAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL GAMAL
Provider First Name:
HESHAM
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285615245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44192-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-353-7069
Provider Business Mailing Address Fax Number:
419-353-7076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 W WOOSTER ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43402-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-373-7692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  35.084310 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: 35.084310 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 35.084310 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7169581 . This is a "AETNA PPO PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A97968 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A979680 . This is a "BLUE SHIELD PPO PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2492959 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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