=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053553925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADIA M CHAMMAS-AOUN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 02/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1735 27TH ST WALLER BUILDING, SUITE 108
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-356-6891
-----------------------------------------------------
Fax | 740-354-6774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 27TH ST WALLER BUILDING, SUITE B06
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-356-8008
-----------------------------------------------------
Fax | 740-353-7900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD13435
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35099804
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------