Provider Demographics
NPI:1568718344
Name:FADILA, MARIO FAHMY BISHARA SEMAAN (MBCHB)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:FAHMY BISHARA SEMAAN
Last Name:FADILA
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16222 W US HIGHWAY 24 STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8763
Mailing Address - Country:US
Mailing Address - Phone:719-686-2832
Mailing Address - Fax:719-686-2833
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:DC043.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:573-882-0808
Practice Address - Fax:573-882-8788
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0058664207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program