Provider Demographics
NPI:1942257852
Name:EL-GHONEIMY, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:EL-GHONEIMY
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 1:1341 S ELISEO DR
Mailing Address - Street 2:200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2000
Mailing Address - Country:US
Mailing Address - Phone:415-464-8176
Mailing Address - Fax:415-464-8177
Practice Address - Street 1:1341 S ELISEO DR
Practice Address - Street 2:200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2000
Practice Address - Country:US
Practice Address - Phone:415-464-8176
Practice Address - Fax:415-464-8177
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93235207Q00000X
CA00093235207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942257852Medicaid
CAH63253Medicare UPIN
CA00A932351Medicare Oscar/Certification