Healthcare Provider Details

I. General information

NPI: 1366850711
Provider Name (Legal Business Name): FAISAL RADWI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 IBN HENIN AS SAFA DISTRICT
JEDDAH WESTERN
23456 4130
SA

IV. Provider business mailing address

20 YORK ST
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 681-214-3099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD-51073
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0116031187
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: