Provider Demographics
NPI:1508207689
Name:MARMOUSH, FADY (MD)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:MARMOUSH
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 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-444-7464
Mailing Address - Fax:480-355-1798
Practice Address - Street 1:5882 S HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9455
Practice Address - Country:US
Practice Address - Phone:928-793-3747
Practice Address - Fax:928-793-3745
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02886207R00000X
AZ59719207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology