MEDICARE: DR. JESSICA EDEN FAZEKAS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	OS16388	FL
2	2085R0202X	Diagnostic Radiology Physician	240861-01	NY
3	2085R0202X	Diagnostic Radiology Physician	25MB08623000	NJ
4	2085R0202X	Diagnostic Radiology Physician	010710	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609938281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA EDEN FAZEKAS D.O.

Provider Business Mailing Address
First Line	:	700 E MOREHEAD ST STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	677 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2701
Country	:	US
Telephone Number	:	520-795-2889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/18/2026

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