Healthcare Provider Details

I. General information

NPI: 1770150211
Provider Name (Legal Business Name): FIDINI HAYATI ANTONI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date: 04/03/2023
Reactivation Date: 05/01/2023

III. Provider practice location address

12502 WILLOWBROOK RD STE 330
CUMBERLAND MD
21502-6498
US

IV. Provider business mailing address

12502 WILLOWBROOK RD STE 330
CUMBERLAND MD
21502-6498
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8900
  • Fax:
Mailing address:
  • Phone: 240-964-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0106018
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: