Provider Demographics
NPI:1801866017
Name:SHEHATA, WAGIH M (MD)
Entity Type:Individual
Prefix:DR
First Name:WAGIH
Middle Name:M
Last Name:SHEHATA
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:DEPT 2289
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-421-3504
Mailing Address - Fax:513-231-7055
Practice Address - Street 1:7691 FIVE MILE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-381-2455
Practice Address - Fax:513-231-7055
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035374S2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00318434OtherRR MCARE ECC
OHP00303025OtherRR MEDICARE CCC
OH0530796Medicaid
OHP00395603OtherRR MEDICARE ERO
OHC02900Medicare UPIN
OH0861882Medicare PIN
OH0563392Medicare PIN
OHSH0861881Medicare PIN
IN212680Medicare PIN
OHP00395603OtherRR MEDICARE ERO
OH0530796Medicaid
OH0861883Medicare PIN