Healthcare Provider Details

I. General information

NPI: 1013913243
Provider Name (Legal Business Name): FADIA M ABAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 HOLLAND RD STE 100
MAUMEE OH
43537-4206
US

IV. Provider business mailing address

1661 HOLLAND RD STE 100
MAUMEE OH
43537-4206
US

V. Phone/Fax

Practice location:
  • Phone: 419-891-6262
  • Fax: 419-891-6263
Mailing address:
  • Phone: 419-891-6262
  • Fax: 419-891-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35039670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: