Provider Demographics
NPI:1639283914
Name:ABBASS, FADI (MD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:ABBASS
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-228-3335
Mailing Address - Fax:419-998-4514
Practice Address - Street 1:1220 E ELM ST STE 106
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2803
Practice Address - Country:US
Practice Address - Phone:419-998-8244
Practice Address - Fax:419-998-8243
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082113207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2400226Medicaid
OH2400226Medicaid
OH4104737Medicare PIN