Healthcare Provider Details

I. General information

NPI: 1780721753
Provider Name (Legal Business Name): MARISA S GARCIA FAUST PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8341 PIONEER DRIVE
SEVERN MD
21144
US

IV. Provider business mailing address

2204 MARYLAND AVENUE
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-467-6040
  • Fax: 410-735-5898
Mailing address:
  • Phone: 410-467-6040
  • Fax: 410-735-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001927
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: