MEDICARE: RICHARD J. GHATTAS, M.D., PA

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1114242708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J. GHATTAS, M.D., PA

Provider Business Mailing Address
First Line	:	2425 SOLOMONS ISLAND RD
Second Line	:
City	:	HUNTINGTOWN
State	:	MD
Zip	:	20639-8732
Country	:	US
Telephone Number	:	301-855-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 SOLOMONS ISLAND RD
Second Line	:
City	:	HUNTINGTOWN
State	:	MD
Zip	:	20639-8732
Country	:	US
Telephone Number	:	301-855-1720
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD JOSEPH GHATTAS
Credential	:	M.D.
Telephone Number	:	301-855-1720

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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