Provider Demographics
NPI:1346440146
Name:FATHY, TAMER MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMER
Middle Name:MOHAMED
Last Name:FATHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:123 17TH STREET
Mailing Address - Street 2:MAIL STOP 316
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0001
Mailing Address - Country:US
Mailing Address - Phone:775-784-6180
Mailing Address - Fax:775-784-4473
Practice Address - Street 1:2200 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4106
Practice Address - Country:US
Practice Address - Phone:570-759-1228
Practice Address - Fax:570-759-2017
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAFF0382185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039402260001Medicaid
PAFA1V5458OtherMEDICARE