MEDICARE: DR. JOHN P FATH LCPC

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	LC0023	MD

General Provider Information

NPI Number	:	1548484843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P FATH LCPC

Provider Business Mailing Address
First Line	:	1001 SPRING ST
Second Line	:	SUITE 104
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4022
Country	:	US
Telephone Number	:	301-565-2145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 SPRING ST
Second Line	:	SUITE 104
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4022
Country	:	US
Telephone Number	:	301-565-2145
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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