Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | D26478 | MD |
NPI | 1659420990 |
---|---|
Provider Name | Dr. Stephen R Fahey |
First Address | College Park, MD 20742-0001 |
Second Address | College Park, MD 20742-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |