Basic Information
| Provider Information | |||||||||
| NPI: | 1477883486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAI | ||||||||
| FirstName: | EMMANUEL | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PA-C, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 827 LINDEN AVENUE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102258000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8118 GOOD LUCK RD | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207063574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015528130 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 01/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0004092 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | CO4092 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.