Provider Demographics
NPI:1790853497
Name:GHANEIE, AREZOO (MD)
Entity Type:Individual
Prefix:
First Name:AREZOO
Middle Name:
Last Name:GHANEIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE B20
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-2494
Mailing Address - Fax:610-645-4456
Practice Address - Street 1:100 E LANCASTER AVE STE B20
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-2494
Practice Address - Fax:610-645-4456
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009263207RH0003X
NJ25MA08288500207RH0003X
PAMD422898207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018042430001Medicaid
PA1009510001Medicare NSC
NJ118806RVOMedicare PIN
PA110818G48Medicare PIN
PAI73324Medicare UPIN