Basic Information
| Provider Information | |||||||||
| NPI: | 1346440146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FATHY | ||||||||
| FirstName: | TAMER | ||||||||
| MiddleName: | MOHAMED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 17TH STREET | ||||||||
| Address2: | MAIL STOP 316 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757846180 | ||||||||
| FaxNumber: | 7757844473 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BERWICK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186034106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707591228 | ||||||||
| FaxNumber: | 5707592017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FF0382185 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1039402260001 | 05 | PA | MEDICAID | FA1V5458 | 01 | PA | MEDICARE | OTHER |