Provider Demographics
NPI:1780787184
Name:KAYFAN, GLORIA DAEMI (DO)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:DAEMI
Last Name:KAYFAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MIDDLETOWN LOOP # A
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8701
Mailing Address - Country:US
Mailing Address - Phone:304-598-1914
Mailing Address - Fax:
Practice Address - Street 1:140 MIDDLETOWN LOOP
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8701
Practice Address - Country:US
Practice Address - Phone:304-333-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011805207P00000X
GA48431207P00000X
KY03449207P00000X
WV2917207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884177FMedicaid
GA93BDRCQMedicare ID - Type Unspecified
G73757Medicare UPIN
OHH325820Medicare PIN