Healthcare Provider Details

I. General information

NPI: 1972132553
Provider Name (Legal Business Name): ADAM ABEDEL ELLAH FAWAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

2301 ERWIN RD
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2036
  • Fax: 919-684-8944
Mailing address:
  • Phone: 919-684-2036
  • Fax: 919-684-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2026-01926
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: