Basic Information
| Provider Information | |||||||||
| NPI: | 1891994059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDES TAVORA | ||||||||
| FirstName: | FABIO | ||||||||
| MiddleName: | ROCHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 732 EASLEY ST | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209104526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012448433 | ||||||||
| FaxNumber: | 8048361381 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 N BROADWAY ST | ||||||||
| Address2: | WEINBERG BLDG. SUITE 2242 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106146330 | ||||||||
| FaxNumber: | 4432873818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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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 | 207ZP0101X | 4301090336 | MI | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.