Healthcare Provider Details

I. General information

NPI: 1407326580
Provider Name (Legal Business Name): MR. EDMOND FABER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WASHINGTON CIRCLE NW STE 207/208
WASHINGTON DC
20037
US

IV. Provider business mailing address

3 WASHINGTON CIRCLE NW STE 207/208
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 202-955-6001
  • Fax: 202-955-6008
Mailing address:
  • Phone: 202-955-6001
  • Fax: 202-955-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0181
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: