Provider Demographics
NPI:1427781160
Name:GHANEM, NICOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:GHANEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NADIM-NICOLAS
Other - Middle Name:
Other - Last Name:GHANEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:600 HARDIN RD RM 204
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3504
Mailing Address - Country:US
Mailing Address - Phone:501-590-5933
Mailing Address - Fax:
Practice Address - Street 1:4300 W MARKHAM ST # 782
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4024
Practice Address - Country:US
Practice Address - Phone:501-686-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program