Provider Demographics
NPI:1770996373
Name:TAWADROS, FADY MAMDOUH FAYEK (MD)
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:MAMDOUH FAYEK
Last Name:TAWADROS
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 1:6719 GOV GC PEERY HWY
Mailing Address - Street 2:STE 1250
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0379
Mailing Address - Country:US
Mailing Address - Phone:281-923-1512
Mailing Address - Fax:
Practice Address - Street 1:6719 GOV GC PEERY HWY STE 1250
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-0379
Practice Address - Country:US
Practice Address - Phone:276-596-6695
Practice Address - Fax:276-596-6694
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101265913207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program