Provider Demographics
NPI:1336704410
Name:GHAHARI, ELHAM
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:GHAHARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CONN TER STE 550
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3206
Mailing Address - Country:US
Mailing Address - Phone:859-323-5867
Mailing Address - Fax:
Practice Address - Street 1:110 CONN TER STE 550
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-323-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297355207WX0009X
KY55612207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist