MEDICARE: THARWAT A. GHATTAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD.206802	LA
2	207RH0003X	Hematology & Oncology Physician	MD.206802	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043523277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THARWAT A. GHATTAS MD

Provider Business Mailing Address
First Line	:	1455 E BERT KOUNS INDUSTRIAL LOOP
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-5634
Country	:	US
Telephone Number	:	318-798-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 E BERT KOUNS INDUSTRIAL LOOP STE 102
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-6000
Country	:	US
Telephone Number	:	318-798-4595
Fax Number	:	318-798-4595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	02/02/2026

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Directions to “ THARWAT A. GHATTAS MD” Practice Location

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