Provider Information for 1548679525
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Dr. MARIO FAHED M.D.
Sex: Male
NPI: 1548679525
Last Updated: 2019-06-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1548679525 | ||||||||||||
| Enumeration Date | 2014-08-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 263 FARMINGTON AVENUE FARMINGTON, CT 06030-8082 United States Phone: 860-679-6700 | Fax:860-679-6736 | ||||||||||||
| Primary Practice Address | 10 TALCOTT NOTCH FARMINGTON, CT 06032 United States Phone: 860-679-6700 | Fax:860-679-6736 | ||||||||||||
| Secondary Practice Address(es) | 750 E ADAMS ST 950 CAMPBELL AVE 950 CAMPBELL AVE 263 FARMINGTON AVENUE | ||||||||||||
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