Provider Demographics
NPI:1528161619
Name:OHNMACHT, GALEN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:ANTHONY
Last Name:OHNMACHT
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 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:501 MARSHALL ST STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1663
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-973-4541
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055464208G00000X
MS28001208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD165767OtherMEDICARE PTAN
MD5780OtherBRAVO/ELDER HEALTH
MDD0055464OtherSTATE LICENSE
DCO242-0021OtherCARE FIRST BLUE CROSS
MD7377893OtherAETNA PPO
MD1395992OtherAETNA HMO
MD200431OtherJOHNS HOPKINS HEALTH CARE
MD314995OtherAMERIGROUP
MD8892097OtherCIGNA
MD411280600Medicaid
MD888913-02OtherCARE FIRST BLUE CROSS
MD165767OtherMEDICARE PTAN
DCO242-0021OtherCARE FIRST BLUE CROSS