Provider Demographics
NPI:1073680179
Name:FADUL, OSCAR V (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:V
Last Name:FADUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HARLEY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4218
Mailing Address - Country:US
Mailing Address - Phone:256-259-1314
Mailing Address - Fax:256-259-6703
Practice Address - Street 1:507 HARLEY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4218
Practice Address - Country:US
Practice Address - Phone:256-259-1314
Practice Address - Fax:256-259-6703
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09585208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051599042OtherBLUE CROSS/BLUE SHIELD
AL112384Medicaid
AL051599042OtherBLUE CROSS/BLUE SHIELD