Provider Demographics
NPI:1356363253
Name:GHANTOUS, VICTOR ELIAS (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ELIAS
Last Name:GHANTOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:215-657-2018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068220L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02334MD0682207LOtherHEALTH PARTNERS
PA8672780OtherCIGNA
PA0332424000OtherKEYSTONE
0175174602OtherAMERICHOICE
PA390006246OtherRR MEDICARE
PA5333735OtherAETNA
PA1099042OtherKEYSTONE MERCY
PA529058OtherHIGHMARK BLUE SHIELD
PA390006246OtherRR MEDICARE
0175174602OtherAMERICHOICE
PAF77467Medicare UPIN