Provider Demographics
NPI:1407218761
Name:GHALY, MEDHAT (MD)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:GHALY
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 1:64 ROBBINS ST
Mailing Address - Street 2:WATERBURY HOSPITAL
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2613
Mailing Address - Country:US
Mailing Address - Phone:203-573-6162
Mailing Address - Fax:203-573-6707
Practice Address - Street 1:160 ROBBINS ST
Practice Address - Street 2:CHASE OUTPATIENT CENTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2652
Practice Address - Country:US
Practice Address - Phone:203-573-7284
Practice Address - Fax:203-573-7031
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT061928208M00000X
CT61928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine