Healthcare Provider Details

I. General information

NPI: 1932635745
Provider Name (Legal Business Name): DANIAH GHAREEB DHAIFALLAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

11100 EUCLID AVE UNIVERSITY HOSPITAL CLEVELAND MEDICAL CENTER
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number275425
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: