Healthcare Provider Details

I. General information

NPI: 1346345204
Provider Name (Legal Business Name): FADHIL K ABBOUSY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S PROSPECT AVE STE 202
HARTVILLE OH
44632
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-7755
  • Fax: 330-877-7754
Mailing address:
  • Phone: 330-833-5530
  • Fax: 330-833-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35032086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: