Active NPI
Nagwa B Fanous, DMD
- Dentist
- Milford, MA
National Provider Identifier
1831233832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- M15660
- Practice address
- 2 South Main Street
Milford, MA 01757 - Phone
- (508) 478-0106
- Fax
- (508) 478-3247
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | M15660 | MA | Primary |
Addresses
Primary practice location
2 South Main Street
Milford, MA 01757
Mailing address
2 South Main Street
Milford, MA 01757
Phone (508) 478-0106
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0264091 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150527001667 | MA | Order and Referring Only - Dentist | 9436479748 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M15660 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831233832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 SOUTH MAIN STREET",
"city": "MILFORD",
"state": "MA",
"postal_code": "01757",
"telephone_number": "508-478-0106",
"fax_number": "508-478-3247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 SOUTH MAIN STREET",
"city": "MILFORD",
"state": "MA",
"postal_code": "01757",
"telephone_number": "508-478-0106",
"fax_number": "508-478-3247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANOUS",
"first_name": "NAGWA",
"middle_name": "B",
"name_prefix": "Mrs.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "M15660",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0264091",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.