Provider Demographics
NPI:1639144785
Name:GHAZAL-ALBAR, NAMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:NAMAN
Middle Name:A
Last Name:GHAZAL-ALBAR
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:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-0652
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3617
Practice Address - Country:US
Practice Address - Phone:636-200-3811
Practice Address - Fax:636-200-3812
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109210174400000X, 207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1438049OtherUNITED HEALTH CARE
MO205305907Medicaid
MO25817OtherBLUE CROSS BLUE SHIELD
MO142736OtherGHP
MO277909OtherHEALTHLINK
MO82580OtherGHP
MO277909OtherHEALTHLINK
MO1438049OtherUNITED HEALTH CARE
MO000095171Medicare PIN
MOG18509Medicare UPIN