MEDICARE: PATRICK J FAHEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35039496	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083677355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J FAHEY MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120660
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-2700
Fax Number	:	614-293-2720

Provider Business Practice Location Address
First Line	:	2231 NORTH HIGH STREET
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201
Country	:	US
Telephone Number	:	614-293-2700
Fax Number	:	614-293-2720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	02/17/2021

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