Provider Demographics
NPI:1790195402
Name:AMEER, FAWZI MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWZI
Middle Name:MOHAMMAD
Last Name:AMEER
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 1:45 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5536
Mailing Address - Country:US
Mailing Address - Phone:845-453-8698
Mailing Address - Fax:
Practice Address - Street 1:45 RODEO DR
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5536
Practice Address - Country:US
Practice Address - Phone:845-453-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SDPENDING207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program