Healthcare Provider Details

I. General information

NPI: 1033183801
Provider Name (Legal Business Name): FAHIM FAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 STONELEDGE DR
ROANOKE VA
24019-8682
US

IV. Provider business mailing address

103 VALLEY CENTER DR
STAUNTON VA
24401-5080
US

V. Phone/Fax

Practice location:
  • Phone: 540-391-1085
  • Fax:
Mailing address:
  • Phone: 540-332-8139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101231772
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101231772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: