Provider Demographics
NPI:1306988860
Name:FAHMY, RAED N
Entity type:Individual
Prefix:
First Name:RAED
Middle Name:N
Last Name:FAHMY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-627-1244
Mailing Address - Fax:253-627-6576
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-627-1244
Practice Address - Fax:253-627-6576
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038152174400000X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA060057966OtherRAILROAD MEDICARE
WA1708FAOtherREGENCE
WA0249908OtherSTATE L&I
WA0249918OtherSTATE L&I
WA1300FAOtherREGENCE
WA4798FAOtherREGENCE
WARA5891OtherREGENCE
WA1800FAOtherREGENCE
WA8250821Medicaid
WA139457OtherDEPARTMENT OF L&I
WAG8882044Medicare PIN
WA1800FAOtherREGENCE
WAAB13202Medicare ID - Type UnspecifiedMEDICARE
WA139457OtherDEPARTMENT OF L&I