Provider Demographics
NPI:1992968028
Name:MAALOUF CHAHDA, GRACIELA ISMELD (MD)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:ISMELD
Last Name:MAALOUF CHAHDA
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 1:9685 LAKE NONA VILLAGE PLACE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-4643
Mailing Address - Country:US
Mailing Address - Phone:321-888-2631
Mailing Address - Fax:407-352-2547
Practice Address - Street 1:9685 LAKE NONA VILLAGE PLACE
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-3282
Practice Address - Country:US
Practice Address - Phone:321-888-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 112671207R00000X
FLME112671208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005582500Medicaid
FL14L00OtherBCBS
FL14L00OtherBCBS