Provider Demographics
NPI:1912930215
Name:MABROUK, FADIA (MD)
Entity Type:Individual
Prefix:DR
First Name:FADIA
Middle Name:
Last Name:MABROUK
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 1:3814 FAIRHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2046
Mailing Address - Country:US
Mailing Address - Phone:410-515-4300
Mailing Address - Fax:
Practice Address - Street 1:104 PLUMTREE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-515-4300
Practice Address - Fax:410-515-4318
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
012333OtherJOHNS HOPKINS HEALTHCARE
9966OtherKAISER
1164938OtherCIGNA
0012OtherCAREFIRST DC
MD1201790Medicaid
113527OtherCOVENTRY
4674514OtherAETNA PPO
MD93009Medicaid
281939OtherMAMSI
39960901OtherCAREFIRST MARYLAND
1978378OtherUNITED HEALTHCARE
2310489OtherAETNA HMO
700302OtherNCPPO
2310489OtherAETNA HMO