Provider Demographics
NPI:1659533008
Name:EJAZ, ARVIN ASIM DEMETRIA (MD)
Entity Type:Individual
Prefix:
First Name:ARVIN
Middle Name:ASIM DEMETRIA
Last Name:EJAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARVIN
Other - Middle Name:DEMETRIA
Other - Last Name:BERMISA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-525-0005
Mailing Address - Fax:859-525-8806
Practice Address - Street 1:7388 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-0005
Practice Address - Fax:859-525-8806
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78400207RC0000X
OH35129990207RC0000X
IN01087002A207RC0000X
KY50609207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease