Provider Demographics
NPI:1982657391
Name:GHAZAL, ELIE R (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:R
Last Name:GHAZAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-8394
Mailing Address - Fax:937-208-8388
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 3300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-8394
Practice Address - Fax:937-208-8388
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071117G207R00000X
OH35.071117208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2088002Medicaid
OH0834877Medicare PIN
OHGH834875Medicare PIN
OHH098330Medicare PIN
G62604Medicare UPIN
OH2088002Medicaid