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General NPI Number Information
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NPI Number | 1831371509
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Entity Type | Individual
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Provider Name | MARIO TADROS GHANEM MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | KFARZEINA
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City | ZGHARTA
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State | NORTH LEBANON
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Zip | 55555
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Country | LB
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Telephone | 0119616555577
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Fax |
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Provider Business Mailing Address
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Address Line | 19 CHARLOTTE HILL DR
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2000
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Country | US
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Telephone | 443-844-0153
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Fax |
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | D0069933
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License Number State | MD
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