Healthcare Provider Details

I. General information

NPI: 1992857015
Provider Name (Legal Business Name): RICHARD C FIDANZA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1211
US

IV. Provider business mailing address

2770 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1211
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-9000
  • Fax: 410-266-9058
Mailing address:
  • Phone: 410-266-9000
  • Fax: 410-266-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01291
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: