Provider Demographics
NPI:1871531319
Name:GADALLAH, MERRIT FAWZI (MD)
Entity type:Individual
Prefix:DR
First Name:MERRIT
Middle Name:FAWZI
Last Name:GADALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1213 PIPER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1393
Mailing Address - Country:US
Mailing Address - Phone:239-254-0099
Mailing Address - Fax:239-254-1908
Practice Address - Street 1:1213 PIPER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1393
Practice Address - Country:US
Practice Address - Phone:239-254-0099
Practice Address - Fax:239-254-1908
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72275207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250006000Medicaid
28966VMedicare PIN
FL250006000Medicaid