Provider Demographics
NPI:1407981749
Name:UNIVERSITY SPECIALISTS LLP
Entity Type:Organization
Organization Name:UNIVERSITY SPECIALISTS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:FASTOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-2707
Mailing Address - Street 1:7900 WISCONSIN AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3634
Mailing Address - Country:US
Mailing Address - Phone:301-652-2707
Mailing Address - Fax:
Practice Address - Street 1:7900 WISCONSIN AVE STE 406
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3634
Practice Address - Country:US
Practice Address - Phone:301-652-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty