Provider Demographics
NPI:1164978839
Name:FADY A. SINNO,M.D. PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
Entity Type:Organization
Organization Name:FADY A. SINNO,M.D. PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SINNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-884-4200
Mailing Address - Street 1:5300 DORSEY HALL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7791
Mailing Address - Country:US
Mailing Address - Phone:410-884-4200
Mailing Address - Fax:
Practice Address - Street 1:5300 DORSEY HALL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7791
Practice Address - Country:US
Practice Address - Phone:410-884-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FADY A SINNO, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35889208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD502900700Medicaid
MD502900700Medicaid