Healthcare Provider Details

I. General information

NPI: 1669545810
Provider Name (Legal Business Name): MR. DEAN ANDREW MULCASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 TARN TER
FROSTBURG MD
21532-1217
US

IV. Provider business mailing address

17 MOUNT PLEASANT ST
FROSTBURG MD
21532-1317
US

V. Phone/Fax

Practice location:
  • Phone: 301-689-3497
  • Fax: 301-689-6251
Mailing address:
  • Phone: 301-687-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: