Provider Demographics
NPI:1417915521
Name:FAHEID, EHAB M (M D)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:M
Last Name:FAHEID
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4101
Mailing Address - Country:US
Mailing Address - Phone:903-454-6000
Mailing Address - Fax:903-455-7980
Practice Address - Street 1:301 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4101
Practice Address - Country:US
Practice Address - Phone:903-454-6000
Practice Address - Fax:903-455-7980
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7995202Medicaid
NJ7995202Medicaid
NJ084688Medicare ID - Type UnspecifiedCORPORATION
NJG94576Medicare UPIN