Healthcare Provider Details

I. General information

NPI: 1861443103
Provider Name (Legal Business Name): JOSEPH S. FASTOW, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

IV. Provider business mailing address

PO BOX 1436
BALTIMORE MD
21203-1436
US

V. Phone/Fax

Practice location:
  • Phone: 301-855-1012
  • Fax:
Mailing address:
  • Phone: 301-652-2707
  • Fax: 301-907-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH S FASTOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-652-2707