Provider Demographics
NPI:1962715821
Name:FAKHRY, TANNOUS K (MD)
Entity type:Individual
Prefix:
First Name:TANNOUS
Middle Name:K
Last Name:FAKHRY
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 1:145 W 23RD ST STE 303
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2858
Mailing Address - Country:US
Mailing Address - Phone:814-452-7800
Mailing Address - Fax:814-452-7915
Practice Address - Street 1:145 W 23RD ST STE 303
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-452-7800
Practice Address - Fax:814-452-7915
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466712208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery