Provider Demographics
NPI:1184651481
Name:AGHEL, ESSAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:M
Last Name:AGHEL
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 1:4038 GAP RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-5903
Mailing Address - Country:US
Mailing Address - Phone:865-689-5757
Mailing Address - Fax:
Practice Address - Street 1:4038 GAP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-5903
Practice Address - Country:US
Practice Address - Phone:865-689-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37652207P00000X
TN40298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64068430Medicaid
KY64068430Medicaid
KY0975523Medicare PIN