Healthcare Provider Details

I. General information

NPI: 1184616294
Provider Name (Legal Business Name): FADIA T ALDAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 EAST 16TH STREET SUITE A21
INDIANAPOLIS IN
46218-4932
US

IV. Provider business mailing address

505 HAWKS VIEW DRIVE
MARION IN
46952-0000
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-5394
  • Fax:
Mailing address:
  • Phone: 317-919-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01057704A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: