Healthcare Provider Details

I. General information

NPI: 1679512479
Provider Name (Legal Business Name): FADI A MATAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S ARMENIA AVE STE 200
TAMPA FL
33609-3395
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-353-1515
  • Fax: 813-353-0865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME65062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: