=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306988860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAED N FAHMY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11511 CANTERWOOD BLVD STE 100
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-382-3716
-----------------------------------------------------
Fax | 253-858-4978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11511 CANTERWOOD BLVD STE 100
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-382-3716
-----------------------------------------------------
Fax | 253-858-4978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD00038152
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD00038152
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------