Provider Demographics
NPI:1902891625
Name:FAWAZ, RHODY F (MD)
Entity Type:Individual
Prefix:
First Name:RHODY
Middle Name:F
Last Name:FAWAZ
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:PO BOX 631341
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1341
Mailing Address - Country:US
Mailing Address - Phone:864-335-7555
Mailing Address - Fax:833-459-0877
Practice Address - Street 1:317 SAINT FRANCIS DR STE 339
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3965
Practice Address - Country:US
Practice Address - Phone:864-335-7555
Practice Address - Fax:833-459-0877
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86784207RG0100X
OK19976207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK347459115OtherDOL
100016186OtherRAILROAD MEDICARE
OK1000097620BMedicaid
OK7861276OtherAETNA
H28439Medicare UPIN