Healthcare Provider Details

I. General information

NPI: 1740489350
Provider Name (Legal Business Name): MICHAEL FREDERICK FADELL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN ROAD DEPARTMENT OF RADIOLOGY
DURHAM NC
27710-1601
US

IV. Provider business mailing address

725 WELCH RD RM 1890
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-7293
  • Fax:
Mailing address:
  • Phone: 650-725-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC166708
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number56242
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.086097
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC166708
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number312296
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: