Healthcare Provider Details

I. General information

NPI: 1285600544
Provider Name (Legal Business Name): WAGDY GHALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OHIO ST
MEDINA NY
14103-1063
US

IV. Provider business mailing address

534 MAIN ST STE 14
MEDINA NY
14103-1436
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-3992
  • Fax: 585-798-3865
Mailing address:
  • Phone: 585-798-3992
  • Fax: 585-798-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number134392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: