Healthcare Provider Details

I. General information

NPI: 1619146859
Provider Name (Legal Business Name): CARDIOLOGISTS OF GREENE COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 LAKEVIEW DR SUITE D
BEAVERCREEK OH
45431-4600
US

IV. Provider business mailing address

2365 LAKEVIEW DR SUITE D
BEAVERCREEK OH
45431-4600
US

V. Phone/Fax

Practice location:
  • Phone: 937-376-8336
  • Fax: 937-376-8352
Mailing address:
  • Phone: 937-376-8336
  • Fax: 937-376-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF KORAYM
Title or Position: OWNER
Credential: MD
Phone: 937-376-8336