Provider Demographics
NPI:1770309791
Name:AL GHANIM, AHMED MOHAMED
Entity type:Individual
Prefix:MR
First Name:AHMED
Middle Name:MOHAMED
Last Name:AL GHANIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RIVERWYNDE DR
Mailing Address - Street 2:
Mailing Address - City:ARUNDEL
Mailing Address - State:ME
Mailing Address - Zip Code:04046-7504
Mailing Address - Country:US
Mailing Address - Phone:207-303-9113
Mailing Address - Fax:
Practice Address - Street 1:13 RIVERWYNDE DR
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-7504
Practice Address - Country:US
Practice Address - Phone:207-303-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant