Healthcare Provider Details

I. General information

NPI: 1750367975
Provider Name (Legal Business Name): MOHAMED M FAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GORMAN AVE
ELKINS WV
26241-3181
US

IV. Provider business mailing address

812 GORMAN AVE
ELKINS WV
26241-3181
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-3533
  • Fax: 304-637-3440
Mailing address:
  • Phone: 304-637-3533
  • Fax: 304-637-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20878
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20878
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: