Provider Demographics
NPI:1447255872
Name:FEGHALI, EDOUARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDOUARD
Middle Name:
Last Name:FEGHALI
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:P O BOX 637407
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7407
Mailing Address - Country:US
Mailing Address - Phone:513-751-5900
Mailing Address - Fax:513-487-4590
Practice Address - Street 1:3440 BURNET AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2833
Practice Address - Country:US
Practice Address - Phone:513-751-5900
Practice Address - Fax:513-487-4590
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040477207V00000X
OH35-040477207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356770Medicaid
KY64786940Medicaid
IN200177630Medicaid
KY64786940Medicaid
OHA80052Medicare UPIN
OH0455026Medicare PIN
OH0455022Medicare PIN
OH0356770Medicaid