=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659491439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIK ANTHONY FABRIZIANI ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 E CHURCHVILLE RD
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-838-8333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4231 GOODSON CT
-----------------------------------------------------
City | BELCAMP
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21017-1453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-272-6628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------