Provider Demographics
NPI:1194759118
Name:GHORY, ANN CLARK (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:CLARK
Last Name:GHORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 STATE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2498
Mailing Address - Country:US
Mailing Address - Phone:513-624-1901
Mailing Address - Fax:513-624-1905
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2498
Practice Address - Country:US
Practice Address - Phone:513-624-1901
Practice Address - Fax:513-624-1905
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039742207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0496735Medicaid
OH0496735Medicaid
OH0461074Medicare PIN
OH0461079Medicare PIN
OHA78349Medicare UPIN
OH0461077Medicare PIN