Provider Demographics
NPI:1164717054
Name:FADDOUL, GIOVANNI (MD)
Entity type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:
Last Name:FADDOUL
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 1:25 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3462
Mailing Address - Country:US
Mailing Address - Phone:518-262-5176
Mailing Address - Fax:518-262-5573
Practice Address - Street 1:25 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3462
Practice Address - Country:US
Practice Address - Phone:518-262-5176
Practice Address - Fax:518-262-5573
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302711207RN0300X
SC40409207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty