1467779488 NPI number — FAUSTO Q. AQUINO, JR.,M.D.,P.A.

Table of content: (NPI 1467779488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467779488 NPI number — FAUSTO Q. AQUINO, JR.,M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAUSTO Q. AQUINO, JR.,M.D.,P.A.
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:
1467779488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8713 HARFORD RD
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-4650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-665-1990
Provider Business Mailing Address Fax Number:
410-665-9980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8713 HARFORD RD
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-4650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-665-1990
Provider Business Practice Location Address Fax Number:
410-665-9980
Provider Enumeration Date:
04/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AQUINO
Authorized Official First Name:
FAUSTO
Authorized Official Middle Name:
QUIAMBAO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-665-1990

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  D014697 , 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: 1167FQ . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4104832 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 051331800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04309011 . This is a "UNITED HEALTCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 10075 . This is a "EHP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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