Provider Demographics
NPI:1457302713
Name:HOSPITAL PHYSICIAN SERVICES, LLLP
Entity Type:Organization
Organization Name:HOSPITAL PHYSICIAN SERVICES, LLLP
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:PO BOX 22249
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-4249
Mailing Address - Country:US
Mailing Address - Phone:301-652-2707
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5726
Practice Address - Country:US
Practice Address - Phone:410-848-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08794Medicare PIN
MD630LMedicare PIN
MD584LMedicare PIN
DCG00088Medicare PIN