MEDICARE: DR. FADI GHADBAN 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	207R00000X	Internal Medicine Physician	225169	NY
2	207R00000X	Internal Medicine Physician	39166	IA

General Provider Information

NPI Number	:	1528139706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FADI GHADBAN MD

Provider Business Mailing Address
First Line	:	344 80TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 S WHITE ST
Second Line	:
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	319-385-3141
Fax Number	:

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	04/05/2020

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