Individual
MAHMOUD F FATHALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
179 N BROAD ST, NORWICH, NY 13815-1019
(607) 337-4271
(607) 337-4049
Mailing address
179 N BROAD ST, NORWICH, NY 13815-1019
(607) 337-4271
(607) 337-4049
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200069
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01593622
—
NY
Enumeration date
10/18/2006
Last updated
07/24/2013
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