Provider Demographics
NPI:1083038038
Name:KAMEL H GHANDOUR M.D., LLC
Entity Type:Organization
Organization Name:KAMEL H GHANDOUR M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SWAMIDOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-901-2222
Mailing Address - Street 1:107 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3001
Mailing Address - Country:US
Mailing Address - Phone:203-901-2222
Mailing Address - Fax:
Practice Address - Street 1:107 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3001
Practice Address - Country:US
Practice Address - Phone:203-901-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44176207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01386533Medicare PIN