Provider Demographics
NPI:1245295260
Name:DAMOUNI, FADI E (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:E
Last Name:DAMOUNI
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 1:26744 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4667
Mailing Address - Country:US
Mailing Address - Phone:302-945-0440
Mailing Address - Fax:302-945-0442
Practice Address - Street 1:26744 JOHN J WILLIAMS HWY.
Practice Address - Street 2:SUITE #7
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-945-0440
Practice Address - Fax:302-945-0442
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000874601Medicaid
DE0000874601Medicaid
DEG77383Medicare UPIN