Provider Demographics
NPI:1255332789
Name:WARDEH, GHASSAN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:LOUIS
Last Name:WARDEH
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 1:342 HAMBURG TPKE STE 101
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2166
Mailing Address - Country:US
Mailing Address - Phone:973-942-4140
Mailing Address - Fax:973-942-5070
Practice Address - Street 1:342 HAMBURG TPKE STE 101
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2166
Practice Address - Country:US
Practice Address - Phone:973-942-4140
Practice Address - Fax:973-942-5070
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07703500207RP1001X, 207R00000X
NY233510207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00040117774OtherUHC
NJP616-3453OtherOXFORD
NJ1997788OtherWELLCARE
NJ60420852OtherHORIZON NJ
NJ086482OtherHIGHMARK MEDICARE SERVICES
NJPBS0042956765OtherAMERIHEALTH
PA101206245Medicaid
NY6149915OtherAETNA
NJ07135891OtherAMERIGROUP