Healthcare Provider Details

I. General information

NPI: 1710825682
Provider Name (Legal Business Name): ANDREA FOCAZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

IV. Provider business mailing address

2235 ROGENE DR APT 104
BALTIMORE MD
21209-3430
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 443-866-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number08180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: