1306618780 NPI number — FABCHA HEALTH

Table of content: MR. JOHN BERNARD TALTY P.T (NPI 1568614196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306618780 NPI number — FABCHA HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FABCHA HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306618780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5102 MANNING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-354-5445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5102 MANNING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-354-5445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OFFIT
Authorized Official First Name:
FABIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
240-354-5445

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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