Basic Information
| Provider Information | |||||||||
| NPI: | 1053553925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMMAS-AOUN | ||||||||
| FirstName: | NADIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST | ||||||||
| Address2: | WALLER BUILDING, SUITE B06 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568008 | ||||||||
| FaxNumber: | 7403537900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1735 27TH ST | ||||||||
| Address2: | WALLER BUILDING, SUITE 108 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403566891 | ||||||||
| FaxNumber: | 7403546774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD13435 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35099804 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100292070 | 01 | OH | KENTUCKY MEDICAID | OTHER | 0071675 | 05 | OH | MEDICAID |