Provider Demographics
NPI:1013936517
Name:EID, WAEL E (MD)
Entity Type:Individual
Prefix:
First Name:WAEL
Middle Name:E
Last Name:EID
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-8910
Mailing Address - Fax:859-655-8911
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-8910
Practice Address - Fax:859-655-8911
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5427208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100194110Medicaid
OH0061902Medicaid
SD6005072Medicaid
SD6005073Medicaid
SDS102453Medicare PIN
SDP00279988Medicare PIN
OH0061902Medicaid
P01080763Medicare PIN
KYK036650Medicare PIN