Provider Demographics
NPI:1013913243
Name:ABAZA, FADIA M (MD)
Entity Type:Individual
Prefix:
First Name:FADIA
Middle Name:M
Last Name:ABAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 HOLLAND RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4206
Mailing Address - Country:US
Mailing Address - Phone:419-891-6262
Mailing Address - Fax:419-891-6263
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:STE 100
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4206
Practice Address - Country:US
Practice Address - Phone:419-891-6262
Practice Address - Fax:419-891-6263
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141261OtherANTHEM
OH00001OtherPARAMOUNT
OH12-01169OtherUHC
OH0318409Medicaid
OH0633277OtherAETNA
OHAB0803062Medicare ID - Type Unspecified
OH00001OtherPARAMOUNT