MEDICARE: DR. HOSSAM ELDIN FADEL 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	207VM0101X	Maternal & Fetal Medicine Physician	017172	GA

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	:	1558353193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSSAM ELDIN FADEL MD

Provider Business Mailing Address
First Line	:	1348 WALTON WAY
Second Line	:	SUITE 5500
City	:	AUGUSTA
State	:	GA
Zip	:	30901-5104
Country	:	US
Telephone Number	:	706-724-2148
Fax Number	:	706-724-1908

Provider Business Practice Location Address
First Line	:	1348 WALTON WAY
Second Line	:	SUITE 5500
City	:	AUGUSTA
State	:	GA
Zip	:	30901-5104
Country	:	US
Telephone Number	:	706-724-2148
Fax Number	:	706-724-1908

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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