Provider Demographics
NPI:1356469811
Name:FOAD, FAZL A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAZL
Middle Name:A
Last Name:FOAD
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 1:190 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2036
Mailing Address - Country:US
Mailing Address - Phone:610-565-1895
Mailing Address - Fax:
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:215-863-2320
Practice Address - Fax:215-863-2368
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034677L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB39830Medicare UPIN
PAFO148184Medicare ID - Type Unspecified