Provider Demographics
NPI:1255324455
Name:GAYED, NABIL A (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:A
Last Name:GAYED
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 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:2810 THEATER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-7978
Practice Address - Country:US
Practice Address - Phone:260-358-0053
Practice Address - Fax:260-358-0054
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-03-26
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
IN01032592A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000610872OtherANTHEM
IN100138130VMedicaid
IN100138130AMedicaid
INP00717119OtherMEDICARE RR
IN000000610872OtherANTHEM
IN371200Medicare PIN
IN100138130AMedicaid