Healthcare Provider Details

I. General information

NPI: 1417218538
Provider Name (Legal Business Name): AHMED M GHARIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR CRC ROOM 3-5340, MSC1263
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DR CRC ROOM 3-5340, MSC1263
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-451-8982
  • Fax:
Mailing address:
  • Phone: 301-451-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberD0058822
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberD0058822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: