Healthcare Provider Details

I. General information

NPI: 1255586657
Provider Name (Legal Business Name): ANTHONY S GAROFANO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TOLL HOUSE AVE STE A3
FREDERICK MD
21701-6110
US

IV. Provider business mailing address

801 TOLL HOUSE AVE STE A3
FREDERICK MD
21701-6110
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-1411
  • Fax: 301-663-1412
Mailing address:
  • Phone: 301-663-1411
  • Fax: 301-663-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number04034
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0001143
License Number StateMD

VIII. Authorized Official

Name: ANTHONY GAROFANO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-663-1411