Ebtisam Faddoul, PA-C
NPI 1114294055ActiveIndividual· Physician Assistant· Stamford, CT
Physician Assistant (PA-C) in Stamford, Connecticut, trained at Mercy College (class of 2011). Enrolled in Medicare as practitioner - physician assistant and practitioner - physician assistant.
Overview
| NPI | 1114294055 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | Nov 21, 2011 |
| Last updated in NPPES | Jul 19, 2022 |
| Certified by provider | Jul 19, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 015255-1 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (CT); Practitioner - Physician Assistant (NY) |
|---|
Education and affiliations
| Medical school | Mercy College |
|---|---|
| Graduation year | 2011 |
| Medicare specialty | Physician Assistant |
Medical group
- Stamford Health Medical Group IncStamford, CT · 444 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 81 physician assistants in Stamford · All physician assistants in Connecticut