Healthcare Provider Details

I. General information

NPI: 1538083274
Provider Name (Legal Business Name): FAHAD ALDAWSARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DRIVE MSC 226 DIVISION OF VASCULAR & INTERVENTIONAL RADIOLOGY
CHARLESTON SC
29425
US

IV. Provider business mailing address

99 WESTEDGE ST
CHARLESTON SC
29403-4717
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9271
  • Fax:
Mailing address:
  • Phone: 843-330-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMDD.LL97572
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: