Healthcare Provider Details

I. General information

NPI: 1346440146
Provider Name (Legal Business Name): TAMER MOHAMED FATHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W FRONT ST
BERWICK PA
18603-4106
US

IV. Provider business mailing address

123 17TH STREET MAIL STOP 316
RENO NV
89557-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-1228
  • Fax: 570-759-2017
Mailing address:
  • Phone: 775-784-6180
  • Fax: 775-784-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFF0382185
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: