Provider Demographics
NPI:1568401024
Name:GHANDOUR, KAMEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMEL
Middle Name:H
Last Name:GHANDOUR
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 1:107 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3001
Mailing Address - Country:US
Mailing Address - Phone:203-658-7588
Mailing Address - Fax:203-658-7577
Practice Address - Street 1:107 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3001
Practice Address - Country:US
Practice Address - Phone:203-658-7588
Practice Address - Fax:203-658-7588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044176207L00000X, 208VP0000X, 208VP0014X
NY252468207L00000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine