Basic Information
| Provider Information | |||||||||
| NPI: | 1538347422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARCOS S FALTAMO CRNA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 LYONS CREEK ROAD | ||||||||
| Address2: | |||||||||
| City: | DUNKIRK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207544000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013170020 | ||||||||
| FaxNumber: | 3013170028 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MERCANTILE LN | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013170020 | ||||||||
| FaxNumber: | 3013170028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2008 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | FALTAMO | ||||||||
| AuthorizedOfficialFirstName: | MARCOS | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3013170020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R143174 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 631900900 | 05 | MD | MEDICAID | DE4370 | 01 | GA | RAILROAD MEDICARE | OTHER | 358CMA | 01 | MD CAREFIRST | OTHER | G02224 | 01 | DC | MEDICARE PIN | OTHER | K947 | 01 | DC CAREFIRST | OTHER |