Provider Demographics
NPI:1376842799
Name:ALBEZARGAN, FATIN SHAKIR (MD)
Entity Type:Individual
Prefix:
First Name:FATIN
Middle Name:SHAKIR
Last Name:ALBEZARGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FATIN
Other - Middle Name:SHAKIR
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3028 CARING WAY UNIT 9
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5300
Mailing Address - Country:US
Mailing Address - Phone:941-979-9246
Mailing Address - Fax:941-979-9347
Practice Address - Street 1:3028 CARING WAY UNIT 9
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5300
Practice Address - Country:US
Practice Address - Phone:941-979-9246
Practice Address - Fax:941-979-9347
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143731207Q00000X, 207Q00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
08011977OtherDOB
OH0109020Medicaid
08011977OtherDOB
OHH403340Medicare PIN