MEDICARE: DR. DEAN L FIERGANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	D0050510	MD

General Provider Information

NPI Number	:	1346276243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN L FIERGANG MD

Provider Business Mailing Address
First Line	:	2 HAMILL RD
Second Line	:	SUITE 345
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1806
Country	:	US
Telephone Number	:	410-433-8488
Fax Number	:	410-435-2331

Provider Business Practice Location Address
First Line	:	2 HAMILL RD
Second Line	:	SUITE 345
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1806
Country	:	US
Telephone Number	:	410-433-8488
Fax Number	:	410-435-2331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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