Provider Demographics
NPI:1043201627
Name:GHALEB, MELHEM R (MD)
Entity Type:Individual
Prefix:DR
First Name:MELHEM
Middle Name:R
Last Name:GHALEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2705
Mailing Address - Country:US
Mailing Address - Phone:915-521-7620
Mailing Address - Fax:915-521-7842
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-521-7620
Practice Address - Fax:915-521-7842
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL33092085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX46850287OtherMEDICAID NM
TXP00363937OtherMEDICARE RR
TX14475340102OtherEL PASO STAR
TXMDH42792TXOtherWORKERS COMP
TX144753403Medicaid
TX54831OtherPRESBY MEDICAID
TX14475340104OtherEL PASO FIRST
TX144753404Medicaid
TX85615YOtherBCBS
TX54831OtherPRESBY MEDICAID
TXMDH42792TXOtherWORKERS COMP
TX85615YOtherBCBS