Provider Demographics
NPI: | 1255324455 |
---|---|
Name: | GAYED, NABIL A (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NABIL |
Middle Name: | A |
Last Name: | GAYED |
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: | 1234 E DUPONT RD |
Mailing Address - Street 2: | SUITE 1 |
Mailing Address - City: | FORT WAYNE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46825-1545 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 260-373-9700 |
Mailing Address - Fax: | 260-373-9740 |
Practice Address - Street 1: | 2810 THEATER AVE |
Practice Address - Street 2: | |
Practice Address - City: | HUNTINGTON |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46750-7978 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-358-0053 |
Practice Address - Fax: | 260-358-0054 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-24 |
Last Update Date: | 2013-03-26 |
Deactivation Date: | 2006-03-27 |
Deactivation Code: | |
Reactivation Date: | 2006-04-13 |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01032592A | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 000000610872 | Other | ANTHEM |
IN | 100138130V | Medicaid | |
IN | 100138130A | Medicaid | |
IN | P00717119 | Other | MEDICARE RR |
IN | 000000610872 | Other | ANTHEM |
IN | 371200 | Medicare PIN | |
IN | 100138130A | Medicaid |