Provider Demographics
NPI:1801359393
Name:ABDELFATTAH, NIZAR (MD)
Entity type:Individual
Prefix:DR
First Name:NIZAR
Middle Name:
Last Name:ABDELFATTAH
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 1:130 BLUE CREST LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3685
Mailing Address - Country:US
Mailing Address - Phone:202-617-8422
Mailing Address - Fax:
Practice Address - Street 1:100 E CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3205
Practice Address - Country:US
Practice Address - Phone:626-269-5371
Practice Address - Fax:626-577-2100
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC260919207W00000X
CAPENDING207WX0107X
390200000X
CT78979207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program