Provider Demographics
NPI:1104916675
Name:GHALEB, AHMED (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:GHALEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4492
Mailing Address - Country:US
Mailing Address - Phone:501-219-1114
Mailing Address - Fax:501-219-1115
Practice Address - Street 1:11220 EXECUTIVE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4492
Practice Address - Country:US
Practice Address - Phone:501-219-1114
Practice Address - Fax:501-219-1115
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3215207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR050086527OtherRAILROAD MEDICARE
AR146584001Medicaid
ARP00020406OtherRAILROAD MEDICARE
ARP00020406OtherRAILROAD MEDICARE
AR146584001Medicaid