MEDICARE: DR. ANIA GHEYARA MD, PHD

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	207ZP0101X	Anatomic Pathology Physician	A78575	CA

General Provider Information

NPI Number	:	1619489242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANIA GHEYARA MD, PHD

Provider Business Mailing Address
First Line	:	16 RICH ACRES RD
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-1618
Country	:	US
Telephone Number	:	408-674-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 RICH ACRES RD
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-1618
Country	:	US
Telephone Number	:	408-674-6146
Fax Number	:

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

Provider Enumeration Date	:	11/05/2017
Last Update Date	:	11/05/2017

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