Provider Demographics
NPI:1104827336
Name:FAHMY, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FAHMY
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 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 FRANTZ RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-4144
Practice Address - Country:US
Practice Address - Phone:614-544-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-16-2090-F207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270451Medicaid
OHG26347Medicare UPIN
H293551Medicare PIN
OH0802751Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OH000000119193OtherANTHEM PROVIDER NUMBER