Provider Demographics
NPI:1649217704
Name:NASSIF, FADI FOUAD (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:FOUAD
Last Name:NASSIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FADY
Other - Middle Name:F
Other - Last Name:NASSIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE B300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6338
Practice Address - Country:US
Practice Address - Phone:864-454-4200
Practice Address - Fax:864-454-4205
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21856207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC218561Medicaid
SCP00801528OtherRR MEDICARE
SCG415496904Medicare PIN
SCG41549Medicare UPIN
SC218561Medicaid