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General NPI Number Information
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NPI Number | 1679754360
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Entity Type | Organization
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Legal Business Name | MASSIMO S FIANDACA MD PA
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 11055 LITTLE PATUXENT PKWY # 209
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 410-772-3685
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Fax | 410-772-3686
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Provider Business Mailing Address
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Address Line | 11055 LITTLE PATUXENT PKWY #209
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 410-772-3685
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Fax | 410-772-3686
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MASSIMO SALVATORE FIANDACA
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Credential | M.D
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Telephone | 410-925-8526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | D41956
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License Number State | MD
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