Healthcare Provider Details

I. General information

NPI: 1912930215
Provider Name (Legal Business Name): FADIA MABROUK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/05/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PLUMTREE RD SUITE 115
BEL AIR MD
21015-6095
US

IV. Provider business mailing address

3814 FAIRHAVEN TER
ABINGDON MD
21009-2046
US

V. Phone/Fax

Practice location:
  • Phone: 410-515-4300
  • Fax: 410-515-4318
Mailing address:
  • Phone: 410-515-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0028558
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: