Healthcare Provider Details

I. General information

NPI: 1073429130
Provider Name (Legal Business Name): DYLAN HENRY FEARING
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 104
LARGO MD
20774-3703
US

IV. Provider business mailing address

1450 IRVING ST NW APT 5
WASHINGTON DC
20010-2809
US

V. Phone/Fax

Practice location:
  • Phone: 240-334-4394
  • Fax:
Mailing address:
  • Phone: 512-496-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: