Provider Demographics
NPI:1326263336
Name:GHANAMI, RACHEED JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:RACHEED
Middle Name:JOSEPH
Last Name:GHANAMI
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 1:155 HOSPITAL DR
Mailing Address - Street 2:STE 410
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-289-9700
Mailing Address - Fax:337-289-9702
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:STE 410
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-289-9700
Practice Address - Fax:337-289-9702
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA041677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445819Medicaid
LA1445819Medicaid