MEDICARE: DR. MANHAL AMJAD GHANMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	3504727	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578639456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANHAL AMJAD GHANMA M.D.

Provider Business Mailing Address
First Line	:	3155 E ERIE AVE
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44052-2549
Country	:	US
Telephone Number	:	440-288-3554
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 RIDGE RD
Second Line	:	215
City	:	PARMA
State	:	OH
Zip	:	44129-2394
Country	:	US
Telephone Number	:	440-288-3554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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