1568613701 NPI number — ASHRAF FANOUS, MD LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568613701 NPI number — ASHRAF FANOUS, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHRAF FANOUS, MD LLC
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:
1568613701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-8252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-997-1494
Provider Business Mailing Address Fax Number:
301-997-1497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41625 PARK AVENUE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-8252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-1494
Provider Business Practice Location Address Fax Number:
301-997-1497
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FANOUS
Authorized Official First Name:
ASHRAF
Authorized Official Middle Name:
FATHI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-997-1494

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  D0064252 , 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)





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