Provider Demographics
NPI:1972484517
Name:HACHICHO, FAYROUZ ALI
Entity type:Individual
Prefix:
First Name:FAYROUZ
Middle Name:ALI
Last Name:HACHICHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LOCUST ST APT 3214
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4321
Mailing Address - Country:US
Mailing Address - Phone:215-955-6000
Mailing Address - Fax:215-955-6000
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4870
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:215-955-6000
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT001075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology