Provider Demographics
NPI:1215918123
Name:FAWAZ, RIMA L (MD)
Entity type:Individual
Prefix:DR
First Name:RIMA
Middle Name:L
Last Name:FAWAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CEDAR STREET, LMP4093, PO BOX 208064
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8064
Mailing Address - Country:US
Mailing Address - Phone:203-785-4649
Mailing Address - Fax:203-737-1384
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-4649
Practice Address - Fax:203-737-1384
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2227952080P0206X
CT641572080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469921OtherTUFTS HEALTH PLAN
MAJ28234OtherBCBS MA
MA2086191Medicaid
I18933Medicare UPIN
MA2086191Medicaid