Provider Demographics
NPI:1912910423
Name:FADUL, NADA ABDELLATIF (MD)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:ABDELLATIF
Last Name:FADUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 S 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1802
Practice Address - Country:US
Practice Address - Phone:402-559-2666
Practice Address - Fax:402-559-2677
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31077207RI0200X
NC2013-01253207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1797POtherBCBS NC
NC1912910423Medicaid
NC1912910423Medicaid