Provider Demographics
NPI:1477546273
Name:FADOOL, ROSEMARY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:FADOOL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 N REEMS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9549
Mailing Address - Country:US
Mailing Address - Phone:623-544-1000
Mailing Address - Fax:623-544-1025
Practice Address - Street 1:15515 N REEMS RD STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9549
Practice Address - Country:US
Practice Address - Phone:623-544-1000
Practice Address - Fax:623-544-1025
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ588006Medicaid
AZ588006Medicaid
75236Medicare PIN