Individual provider · NPI-1

Thomas M Fabian, MD

Radiology, Diagnostic Radiology · Port Charlotte, FL

NPI number1669466462

StatusActive

Last updated in NPPESMar 15, 2016

Details

NPI: 1669466462
Entity type: Individual (NPI-1)
Name: Thomas M Fabian
Credential: MD
Sex: Male
Sole proprietor: Yes
Enumeration date: Sep 7, 2005
Last updated: Mar 15, 2016

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2085R0202X	Radiology, Diagnostic Radiology	ME46901	FL	Yes
2085R0202X	Radiology, Diagnostic Radiology	D76130	MD
2085R0202X	Radiology, Diagnostic Radiology	25.000270	OH

Practice location

2625 Tamiami Trl
Unit 1
Port Charlotte, FL 33952-6478

Phone 941-235-4646 · Fax 941-235-4655

Mailing address

2625 Tamiami Trl Unit 1
Port Charlotte, FL 33952-6403

Phone 877-277-4646 · Fax 941-235-4642

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