Healthcare Provider Details

I. General information

NPI: 1376330217
Provider Name (Legal Business Name): FIZA FATIMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32050 LONG NECK RD
MILLSBORO DE
19966-6228
US

IV. Provider business mailing address

32050 LONG NECK ROAD
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3150
  • Fax:
Mailing address:
  • Phone: 302-645-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7-0018914
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: