MEDICARE: DR. RICHARD GORDON PFAU 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	174400000X	Specialist	D0029194	MD
2	207ND0900X	Dermatopathology Physician	D0029194	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518935485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GORDON PFAU MD

Provider Business Mailing Address
First Line	:	7671 QUARTERFIELD ROAD
Second Line	:	SUITE 200
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

Provider Business Practice Location Address
First Line	:	810 LANDMARK DR STE 117-119
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4987
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	04/03/2018

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