Provider Demographics
NPI:1114135498
Name:GHAZI, LEYLA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:J
Last Name:GHAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2598
Mailing Address - Country:US
Mailing Address - Phone:603-227-7000
Mailing Address - Fax:603-227-7827
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5071
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17870207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106396Medicaid
MD325506900Medicaid
MD966400-01 & 02OtherBLUE CROSS/BLUE SHIELD
MDS062-0396OtherBLUE CROSS/BLUE SHIELD - REGIONAL
NH3106396Medicaid
MD325506900Medicaid