MEDICARE: FAFAVI DAGADU

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	171M00000X	Case Manager/Care Coordinator
2	251E00000X	Home Health Agency	NA0000812205	DC

General Provider Information

NPI Number	:	1609452465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAFAVI DAGADU

Provider Business Mailing Address
First Line	:	4502 MORNING GLORY TRL
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4242
Country	:	US
Telephone Number	:	410-200-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 MORNING GLORY TRL
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4242
Country	:	US
Telephone Number	:	410-200-0707
Fax Number	:	410-200-0707

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

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	01/20/2026

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Directions to “ FAFAVI DAGADU ” Practice Location

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