Provider Demographics
NPI:1003850397
Name:FAHED, GEORGE PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:FAHED
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 1:522 CALLE CASTILLA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2636
Mailing Address - Country:US
Mailing Address - Phone:787-290-5577
Mailing Address - Fax:787-848-6644
Practice Address - Street 1:917 AVE TITO CASTRO
Practice Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 701
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0000
Practice Address - Country:US
Practice Address - Phone:787-290-5577
Practice Address - Fax:787-848-6644
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13251207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13251OtherMEDICAL LICENSE
PRH81957Medicare UPIN
PR0020289Medicare PIN