Provider Demographics
NPI:1649653700
Name:ASFAHAN, FADI (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:ASFAHAN
Suffix:
Gender:
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-878-6000
Mailing Address - Fax:336-716-0030
Practice Address - Street 1:1155 REVOLUTION MILL DR STE 12
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5090
Practice Address - Country:US
Practice Address - Phone:336-402-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143994207R00000X
CAA175521207R00000X, 208M00000X
NC2018-01730208M00000X, 207R00000X
NY302492208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist