Provider Demographics
NPI:1356341911
Name:GOMAA, LAILA IBRAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:LAILA
Middle Name:IBRAHIM
Last Name:GOMAA
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 1:8120 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2141
Mailing Address - Country:US
Mailing Address - Phone:937-291-2511
Mailing Address - Fax:937-291-2523
Practice Address - Street 1:8120 GARNET DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-2141
Practice Address - Country:US
Practice Address - Phone:937-291-2511
Practice Address - Fax:937-291-2523
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35068963G207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000020807OtherANTHEM
311570738026OtherCARESOURCE
OH2032982Medicaid
OH2032982Medicaid
311570738026OtherCARESOURCE