MEDICARE: RAED N FAHMY

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	207RC0000X	Cardiovascular Disease Physician	MD00038152	WA
2	207R00000X	Internal Medicine Physician	MD00038152	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0249918	OTHER	WA	STATE L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306988860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAED N FAHMY

Provider Business Mailing Address
First Line	:	11511 CANTERWOOD BLVD STE 100
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-382-3716
Fax Number	:	253-858-4978

Provider Business Practice Location Address
First Line	:	11511 CANTERWOOD BLVD STE 100
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-382-3716
Fax Number	:	253-858-4978

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	12/02/2025

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1952306037 — LANCE LEBRECHT BEAR M.D.
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11511 CANTERWOOD BLVD NW , STE 205
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1346248754 — MS. ELLEN M HANISCH NURSE PRACTITIONER
Practice Location Address:

11511 CANTERWOOD BLVD , SUITE 45
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1609865831 — MRS. DANA MICHELLE KNUTZEN M.S.
Practice Location Address:

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1669443032 — KENNETH S BERGMAN MD
Practice Location Address:

11511 CANTERWOOD BLVD NW , SUITE 50
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98332-5813

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Directions to “ RAED N FAHMY ” Practice Location

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