Provider Demographics
NPI:1811951494
Name:GHATAN, EVELYN R (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:R
Last Name:GHATAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:R
Other - Last Name:SLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1226 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5102
Mailing Address - Country:US
Mailing Address - Phone:718-253-2053
Mailing Address - Fax:718-253-2051
Practice Address - Street 1:1226 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5102
Practice Address - Country:US
Practice Address - Phone:718-253-2053
Practice Address - Fax:718-253-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics