1215123971 NPI number — DR. FADI ISMAIL ABU-SHAHIN MD

Table of content: DR. FADI ISMAIL ABU-SHAHIN MD (NPI 1215123971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215123971 NPI number — DR. FADI ISMAIL ABU-SHAHIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABU-SHAHIN
Provider First Name:
FADI
Provider Middle Name:
ISMAIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215123971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18220 STATE HIGHWAY 249 STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-737-0435
Provider Business Mailing Address Fax Number:
281-737-0439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 HEALTH CARE DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
PENNINGTON GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24277-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-546-2928
Provider Business Practice Location Address Fax Number:
276-546-2921
Provider Enumeration Date:
09/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  0101250908 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 48715 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: R7364 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)