Provider Demographics
NPI:1407911324
Name:MAGUED FADLY M.D., INC
Entity Type:Organization
Organization Name:MAGUED FADLY M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:R
Authorized Official - Last Name:FADLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-406-7696
Mailing Address - Street 1:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5699
Mailing Address - Country:US
Mailing Address - Phone:818-406-7696
Mailing Address - Fax:818-225-0142
Practice Address - Street 1:23018 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-406-7696
Practice Address - Fax:818-225-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty