Basic Information
| Provider Information | |||||||||
| NPI: | 1497069249 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EMMANUEL | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | FAUGERES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9720 LEATHERFERN TER | ||||||||
| Address2: | APT 101 | ||||||||
| City: | MONTGOMERY VILLAGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208866330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016421304 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6400 GOLDSBORO ROAD SUITE 400 | ||||||||
| Address2: | MASSACHUSETTS AVE SURGERY CENTER | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012630800 | ||||||||
| FaxNumber: | 3012638020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | CERTIFIED ASSISTANT | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.