Provider Demographics
NPI:1679740674
Name:FAZILI, FATIMA RIZWAN (M D)
Entity Type:Individual
Prefix:DR
First Name:FATIMA RIZWAN
Middle Name:
Last Name:FAZILI
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHARPE ST
Mailing Address - Street 2:WYOMING VALLEY FAMILY MEDICINE RESIDENCY PROGRAM
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3715
Mailing Address - Country:US
Mailing Address - Phone:570-558-8900
Mailing Address - Fax:570-552-8919
Practice Address - Street 1:8901 BOONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1659
Practice Address - Country:US
Practice Address - Phone:281-454-0500
Practice Address - Fax:281-454-0516
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 190710207Q00000X
TX6458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine