Provider Demographics
NPI:1902147309
Name:FADUL, ISSAM M (MS)
Entity Type:Individual
Prefix:MR
First Name:ISSAM
Middle Name:M
Last Name:FADUL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N MARKOE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2149
Mailing Address - Country:US
Mailing Address - Phone:267-408-9895
Mailing Address - Fax:
Practice Address - Street 1:723 N MARKOE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2149
Practice Address - Country:US
Practice Address - Phone:267-408-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor