Provider Demographics
NPI:1972745081
Name:GHANEM DAGHESTANI MD PA
Entity Type:Organization
Organization Name:GHANEM DAGHESTANI MD PA
Other - Org Name:HOPE CANCER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHANEM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHESTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-4600
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-1348
Mailing Address - Country:US
Mailing Address - Phone:956-542-8400
Mailing Address - Fax:956-350-0802
Practice Address - Street 1:2717 MICHAEL ANGELO
Practice Address - Street 2:SUITE 303
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1408
Practice Address - Country:US
Practice Address - Phone:956-687-4600
Practice Address - Fax:956-217-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2010-04-21
Deactivation Date:2010-04-13
Deactivation Code:
Reactivation Date:2010-04-21
Provider Licenses
StateLicense IDTaxonomies
TXM2933207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487612727OtherGROUP NPI
TX180265401Medicaid
1295793768OtherINDIVIDUAL NPI
TX00W475Medicare PIN
1295793768OtherINDIVIDUAL NPI