Provider Demographics
NPI:1053793398
Name:FAYAD, MOHAMAD (DO)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:FAYAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 405
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2318
Mailing Address - Country:US
Mailing Address - Phone:702-707-6960
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY STE 405
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2318
Practice Address - Country:US
Practice Address - Phone:702-707-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO31102084V0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology