Provider Demographics
NPI:1023072709
Name:ABDEL FADIL, AHMED ALY (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:ALY
Last Name:ABDEL FADIL
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 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 760
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6358
Mailing Address - Country:US
Mailing Address - Phone:813-374-0406
Mailing Address - Fax:813-374-0940
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 760
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6358
Practice Address - Country:US
Practice Address - Phone:813-374-0406
Practice Address - Fax:813-374-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196563207RP1001X
FLME142340207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG18656Medicare UPIN