Provider Demographics
NPI:1821022708
Name:BASHOUR, FADI N (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:N
Last Name:BASHOUR
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 1:1299 INDUSTRIAL PARKWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-225-6468
Mailing Address - Fax:330-225-6534
Practice Address - Street 1:1299 INDUSTRIAL PARKWAY NORTH
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:330-225-6534
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 065615207RG0100X
OH35065615207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551831Medicaid
OH9275411Medicare PIN
OHG32495Medicare UPIN