=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538627575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR JEAN PIERRE FAURE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2019
-----------------------------------------------------
Last Update Date | 03/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8218 WISCONSIN AVE STE P9
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20814-3138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-525-6450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7707 WISCONSIN AVE APT 240
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20814-6538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | JONATHAN D FAURE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-525-6450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------