1639356116 NPI number — BADR K. GHUMRAWI, M.D. INC.

Table of content: (NPI 1639356116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639356116 NPI number — BADR K. GHUMRAWI, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BADR K. GHUMRAWI, M.D. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639356116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6693 N CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 268A
Provider Business Mailing Address City Name:
RAVENNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44266-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-296-2829
Provider Business Mailing Address Fax Number:
330-296-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6693 N CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 268A
Provider Business Practice Location Address City Name:
RAVENNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44266-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-296-2829
Provider Business Practice Location Address Fax Number:
330-296-7202
Provider Enumeration Date:
01/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GHUMRAWI
Authorized Official First Name:
BADR
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT, OWNER
Authorized Official Telephone Number:
330-296-2829

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35036836 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 35036836 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 35036836 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000129043 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099507636 . This is a "WORKERS COMPENSATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27174 . This is a "NATIONWIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0231538 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4132029 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71479 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100430 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




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