Healthcare Provider Details

I. General information

NPI: 1912347360
Provider Name (Legal Business Name): FAZEL DINARY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 120
CENTERVILLE OH
45459-4071
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-425-4144
  • Fax: 937-425-4146
Mailing address:
  • Phone: 937-762-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.127481
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.127481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: