Provider Demographics
NPI:1164504528
Name:FAUSTINO, DEOGRACIAS VALLAR (MD)
Entity Type:Individual
Prefix:
First Name:DEOGRACIAS
Middle Name:VALLAR
Last Name:FAUSTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEO GRACIAS
Other - Middle Name:VALLAR
Other - Last Name:FAUSTINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:DV FAUSTINO MD PA
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074
Mailing Address - Country:US
Mailing Address - Phone:410-374-4488
Mailing Address - Fax:410-239-0240
Practice Address - Street 1:4111 LOWER BECKLEYSVILLE RD
Practice Address - Street 2:DV FAUSTINO MD PA
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074
Practice Address - Country:US
Practice Address - Phone:410-374-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012901208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009431500Medicaid
MD1467771774OtherSECOND NPI #
MD009431500Medicaid
C48803Medicare UPIN