Provider Demographics
NPI:1154050227
Name:ABOU GHANEM, ODETTE (MD)
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:
Last Name:ABOU GHANEM
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 1:1611 21ST AVENUE SOUTH VUMC DEPARTMENT OF PLASTIC SURGE
Mailing Address - Street 2:D-4207A MEDICAL CENTER NORTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232
Mailing Address - Country:US
Mailing Address - Phone:615-936-3574
Mailing Address - Fax:
Practice Address - Street 1:1611 21ST AVENUE SOUTH VUMC DEPARTMENT OF PLASTIC SURGE
Practice Address - Street 2:D-4207A MEDICAL CENTER NORTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232
Practice Address - Country:US
Practice Address - Phone:615-936-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program