MEDICARE: DR. MAGED L. GHATTAS M.D.

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	207L00000X	Anesthesiology Physician	25MA08212000	NJ
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	25MA08212000	NJ
3	207LH0002X	Hospice and Palliative Medicine (Anesthesiology) Physician	25MA08212000	NJ

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	:	1770574626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGED L. GHATTAS M.D.

Provider Business Mailing Address
First Line	:	901 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-336-1806
Fax Number	:	732-333-8178

Provider Business Practice Location Address
First Line	:	901 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-336-1806
Fax Number	:	732-333-8178

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2014

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Directions to “ DR. MAGED L. GHATTAS M.D.” Practice Location

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