MEDICARE: DR. FARES GENNAOUI M.D.

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	2085N0904X	Nuclear Radiology Physician	45027	MA

General Provider Information

NPI Number	:	1821092107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARES GENNAOUI M.D.

Provider Business Mailing Address
First Line	:	289 PLEASANT ST
Second Line	:	STE 101
City	:	FALL RIVER
State	:	MA
Zip	:	02721-3005
Country	:	US
Telephone Number	:	508-674-0600
Fax Number	:	508-674-0666

Provider Business Practice Location Address
First Line	:	289 PLEASANT ST
Second Line	:	STE 101
City	:	FALL RIVER
State	:	MA
Zip	:	02721-3005
Country	:	US
Telephone Number	:	508-674-0600
Fax Number	:	508-674-0666

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/02/2008

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