1609841642 NPI number — DR. MICHAEL FADDEN MD

Table of content: DR. MICHAEL FADDEN MD (NPI 1609841642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609841642 NPI number — DR. MICHAEL FADDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADDEN
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609841642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660
Provider Second Line Business Mailing Address:
301 RANDOLPH ST
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-479-4306
Provider Business Mailing Address Fax Number:
410-479-1714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 COLLINS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURLOCK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-943-8763
Provider Business Practice Location Address Fax Number:
410-943-8244
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D26388 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4533260 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "MARYLAND PHYSICIANS CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "INFORMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 735683 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41332103 . This is a "CAREFIRST BC/BS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 683716 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 339268 . This is a "MAMSI/ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8118232 . This is a "OPTIMUM CHOICE/MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P16368 . This is a "CAREFIRST BC/BS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6104182 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 784381000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: T5880025 . This is a "CF BC/BS GRP/GHMSI/BL CHO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 031865 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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