Provider Demographics
NPI:1902877806
Name:DAOUK, GHALEB H (MD)
Entity Type:Individual
Prefix:DR
First Name:GHALEB
Middle Name:H
Last Name:DAOUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2115
Mailing Address - Country:US
Mailing Address - Phone:617-489-0928
Mailing Address - Fax:617-489-0927
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6129
Practice Address - Fax:617-730-0569
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA723242080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3125441Medicaid
MA3125441Medicaid
J30617Medicare ID - Type Unspecified