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General NPI Number Information
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NPI Number | 1033183801
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Entity Type | Individual
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Provider Name | FAHIM FAHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 3517 BRANDON AVE SW
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City | ROANOKE
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State | VA
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Zip | 24018-1523
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Country | US
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Telephone | 540-981-1102
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Fax | 540-344-4169
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Provider Business Mailing Address
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Address Line | 301 ELM AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4001
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Country | US
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Telephone | 540-345-9841
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Fax | 540-527-2900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101231772
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101231772
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License Number State | VA
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