Provider Demographics
NPI:1508816778
Name:ZEIDAN, ZEIDAN FADEL (MD)
Entity Type:Individual
Prefix:
First Name:ZEIDAN
Middle Name:FADEL
Last Name:ZEIDAN
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 1:921 LONG DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4874
Mailing Address - Country:US
Mailing Address - Phone:910-417-3410
Mailing Address - Fax:910-417-3420
Practice Address - Street 1:921 LONG DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4874
Practice Address - Country:US
Practice Address - Phone:910-417-3410
Practice Address - Fax:910-417-3420
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989814Medicaid
G14361Medicare UPIN
NC2216252Medicare ID - Type Unspecified