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General NPI Number Information
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NPI Number | 1386868875
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Entity Type | Organization
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Legal Business Name | FADI G. GHANEM, MD PA
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 1111 MEDICAL PLAZA DR SUITE 230
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3476
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Country | US
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Telephone | 281-419-1599
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Fax | 281-898-7632
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Provider Business Mailing Address
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Address Line | PO BOX 7727
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City | SPRING
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State | TX
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Zip | 77387-7727
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Country | US
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Telephone | 281-419-1599
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Fax | 281-898-7632
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FADI G GHANEM
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Credential | M.D.
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Telephone | 281-419-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | H8071
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H8071
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License Number State | TX
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