Healthcare Provider Details

I. General information

NPI: 1356341911
Provider Name (Legal Business Name): LAILA IBRAHIM GOMAA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 GARNET DR
DAYTON OH
45458-2141
US

IV. Provider business mailing address

8120 GARNET DR
DAYTON OH
45458-2141
US

V. Phone/Fax

Practice location:
  • Phone: 937-291-2511
  • Fax: 937-291-2523
Mailing address:
  • Phone: 937-291-2511
  • Fax: 937-291-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35068963G
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: