Provider Demographics
NPI:1497815898
Name:FATEH, ABUL (MD)
Entity type:Individual
Prefix:MR
First Name:ABUL
Middle Name:
Last Name:FATEH
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 1:220 JEFFERSON HTS
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-2110
Mailing Address - Country:US
Mailing Address - Phone:518-943-9146
Mailing Address - Fax:518-943-0441
Practice Address - Street 1:220 JEFFERSON HTS
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-2110
Practice Address - Country:US
Practice Address - Phone:518-943-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1526511208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B15187Medicare UPIN