Provider Demographics
NPI:1306854948
Name:GHANEM, MAGED MAHMOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGED
Middle Name:MAHMOUD
Last Name:GHANEM
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:PO BOX 644850
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-4850
Mailing Address - Country:US
Mailing Address - Phone:412-937-8887
Mailing Address - Fax:412-937-9221
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5980
Practice Address - Fax:824-452-5039
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1983676OtherHIGHMARK
PA001983676Medicaid
PA1983676OtherHIGHMARK