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General NPI Number Information
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NPI Number | 1467771774
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Entity Type | Organization
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Legal Business Name | DEO GRACIAS FAUSTINO MD PA
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4111 LOWER BECKLEYSVILLE RD
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City | HAMPSTEAD
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State | MD
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Zip | 21074-2248
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Country | US
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Telephone | 410-374-4488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 698
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City | HAMPSTEAD
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State | MD
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Zip | 21074-0698
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Country | US
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Telephone | 410-374-4488
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Fax |
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Authorized Official
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Title or Position | INTERNIST
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Name | DEOGRACIAS FAUSTINO
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Credential | MD
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Telephone | 410-374-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0012901
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License Number State | MD
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