Healthcare Provider Details

I. General information

NPI: 1528067733
Provider Name (Legal Business Name): HANY M OGHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 HIGHWAY 15 N SUITE 5
JACKSON KY
41339-8601
US

IV. Provider business mailing address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-693-0116
  • Fax: 606-693-0118
Mailing address:
  • Phone: 606-666-6230
  • Fax: 606-666-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25492
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: