Provider Demographics
NPI:1154749976
Name:KELADA, BASSEM SADIK GHALY (MD)
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:SADIK GHALY
Last Name:KELADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BASSEM
Other - Middle Name:S
Other - Last Name:KELADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 TRINITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-2851
Mailing Address - Country:US
Mailing Address - Phone:559-665-1400
Mailing Address - Fax:
Practice Address - Street 1:401 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2851
Practice Address - Country:US
Practice Address - Phone:724-719-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine