Healthcare Provider Details

I. General information

NPI: 1518935485
Provider Name (Legal Business Name): RICHARD GORDON PFAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LANDMARK DR STE 117-119
GLEN BURNIE MD
21061-4987
US

IV. Provider business mailing address

7671 QUARTERFIELD ROAD SUITE 200
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-0111
  • Fax: 410-582-9155
Mailing address:
  • Phone: 410-766-0111
  • Fax: 410-582-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0029194
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0029194
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: