Provider Demographics
NPI:1053323691
Name:FAHEEM, WAJAHAT (MD)
Entity Type:Individual
Prefix:
First Name:WAJAHAT
Middle Name:
Last Name:FAHEEM
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 1:892 OAKLAWN AVENUE
Mailing Address - Street 2:HALO CLINIC
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-942-3300
Mailing Address - Fax:401-943-5492
Practice Address - Street 1:892 OAKLAWN AVENUE
Practice Address - Street 2:HALO CLINIC
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-942-3300
Practice Address - Fax:401-943-5492
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD108322084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1526417OtherUBH
RI306597OtherBLUE SHIELD
RI410653OtherBLUE CHIP
RI1022310OtherNH BEACON
RI7010518Medicaid
RI7010518Medicaid