Healthcare Provider Details

I. General information

NPI: 1003863945
Provider Name (Legal Business Name): MARY FATEHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 AMITY ST FL 3 OBGYN ASSOCIATES AT LICH
BROOKLYN NY
11201-6004
US

IV. Provider business mailing address

PO BOX 31218 OBGYN ASSOCIATES AT LICH
HARTFORD CT
06150
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1231
  • Fax: 718-780-4987
Mailing address:
  • Phone: 914-328-4500
  • Fax: 845-565-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number194627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: