Provider Demographics
NPI:1447233952
Name:FATTERPAKER, ANIL K (MD)
Entity Type:Individual
Prefix:MR
First Name:ANIL
Middle Name:K
Last Name:FATTERPAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 D MAIDENCHOICE LANE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-788-1177
Mailing Address - Fax:410-788-1179
Practice Address - Street 1:720 D MAIDENCHOICE LANE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-788-1177
Practice Address - Fax:410-788-1179
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018319207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD298546OtherMAMSI
MDR5420001OtherREP BCBS
MD3126Medicaid
MD787571100Medicaid
MD787571100Medicaid
MD3126Medicaid