Provider Demographics
NPI:1346345204
Name:ABBOUSY, FADHIL K (MD)
Entity Type:Individual
Prefix:
First Name:FADHIL
Middle Name:K
Last Name:ABBOUSY
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:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-833-5530
Mailing Address - Fax:330-833-6085
Practice Address - Street 1:650 S PROSPECT AVE
Practice Address - Street 2:STE 202
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632
Practice Address - Country:US
Practice Address - Phone:330-877-7755
Practice Address - Fax:330-877-7754
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158903Medicaid
OH0158903Medicaid
OH0546263Medicare ID - Type Unspecified