1255324455 NPI number — DR. NABIL A GAYED M.D.

Table of content: DR. NABIL A GAYED M.D. (NPI 1255324455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255324455 NPI number — DR. NABIL A GAYED M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAYED
Provider First Name:
NABIL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255324455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/27/2006
NPI Reactivation Date:
04/13/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1234 E DUPONT RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-373-9700
Provider Business Mailing Address Fax Number:
260-373-9740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 THEATER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-7978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-358-0053
Provider Business Practice Location Address Fax Number:
260-358-0054
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  01032592A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000610872 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100138130V , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100138130A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00717119 . This is a "MEDICARE RR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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