Basic Information
| Provider Information | |||||||||
| NPI: | 1306988860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAHMY | ||||||||
| FirstName: | RAED | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 YAKIMA AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536271244 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 YAKIMA AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536271244 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00038152 | WA | N | Other Service Providers | Specialist | 207RC0000X | MD00038152 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | MD00038152 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 060057966 | 01 | WA | RAILROAD MEDICARE | OTHER | 1708FA | 01 | WA | REGENCE | OTHER | 0249908 | 01 | WA | STATE L&I | OTHER | 0249918 | 01 | WA | STATE L&I | OTHER | 1300FA | 01 | WA | REGENCE | OTHER | 4798FA | 01 | WA | REGENCE | OTHER | RA5891 | 01 | WA | REGENCE | OTHER | 1800FA | 01 | WA | REGENCE | OTHER | 8250821 | 05 | WA | MEDICAID | 139457 | 01 | WA | DEPARTMENT OF L&I | OTHER |