Provider Demographics
NPI:1558391433
Name:FAHED FAYAD MD PA
Entity Type:Organization
Organization Name:FAHED FAYAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAHED
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-582-2068
Mailing Address - Street 1:5601 COLLINS AVE APT 612
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2444
Mailing Address - Country:US
Mailing Address - Phone:305-582-2068
Mailing Address - Fax:305-675-0662
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5691
Practice Address - Fax:305-325-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME558542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25169Medicare UPIN