Provider Demographics
NPI:1346796091
Name:ABDELFATTAH, THAER SAQER MUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:THAER
Middle Name:SAQER MUSTAFA
Last Name:ABDELFATTAH
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 1:50 MAUDE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4325
Mailing Address - Country:US
Mailing Address - Phone:401-456-6510
Mailing Address - Fax:
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-6510
Practice Address - Fax:401-456-6852
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2023-10-03
Deactivation Date:2019-06-19
Deactivation Code:
Reactivation Date:2019-06-27
Provider Licenses
StateLicense IDTaxonomies
OH57027521207R00000X
RIMD19125207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine