Provider Demographics
NPI:1073090601
Name:HANAN FAHMY, MD, PA
Entity Type:Organization
Organization Name:HANAN FAHMY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-891-8056
Mailing Address - Street 1:5018 EMPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3455
Mailing Address - Country:US
Mailing Address - Phone:217-891-8056
Mailing Address - Fax:
Practice Address - Street 1:3365 REGENT BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3125
Practice Address - Country:US
Practice Address - Phone:214-716-7573
Practice Address - Fax:888-657-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1628207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty