Provider Demographics
NPI:1831180827
Name:FATTEH, SHOKAT M (MD)
Entity type:Individual
Prefix:DR
First Name:SHOKAT
Middle Name:M
Last Name:FATTEH
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 1:2840 APPALOOSA DR
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2735
Mailing Address - Country:US
Mailing Address - Phone:330-884-3803
Mailing Address - Fax:330-884-3790
Practice Address - Street 1:8166 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6262
Practice Address - Country:US
Practice Address - Phone:330-953-3242
Practice Address - Fax:330-953-3243
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-8777207ZD0900X
OH35048777207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0782854Medicaid
OH35-04-8777OtherOHIO LICENSE NUMBER
OHB79552Medicare UPIN