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General NPI Number Information
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NPI Number | 1568401024
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Entity Type | Individual
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Provider Name | KAMEL H. GHANDOUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 107 GLENBROOK RD
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City | STAMFORD
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State | CT
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Zip | 06902-3001
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Country | US
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Telephone | 203-658-7588
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Fax | 203-658-7588
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Provider Business Mailing Address
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Address Line | 107 GLENBROOK RD
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City | STAMFORD
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State | CT
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Zip | 06902-3001
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Country | US
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Telephone | 203-658-7588
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Fax | 203-658-7577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 044176
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 044176
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 044176
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 252468
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 252468
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 252468
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License Number State | NY
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