Provider Demographics
NPI:1578639456
Name:GHANMA, MANHAL AMJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MANHAL
Middle Name:AMJAD
Last Name:GHANMA
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 1:3155 E ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2549
Mailing Address - Country:US
Mailing Address - Phone:440-288-3554
Mailing Address - Fax:
Practice Address - Street 1:5500 RIDGE RD
Practice Address - Street 2:215
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2394
Practice Address - Country:US
Practice Address - Phone:440-288-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504727207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0633658Medicaid
OH0633658Medicaid
OH0581003Medicare ID - Type Unspecified