Provider Demographics
NPI:1467779488
Name:FAUSTO Q. AQUINO, JR.,M.D.,P.A.
Entity Type:Organization
Organization Name:FAUSTO Q. AQUINO, JR.,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:QUIAMBAO
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-665-1990
Mailing Address - Street 1:8713 HARFORD RD
Mailing Address - Street 2:101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4650
Mailing Address - Country:US
Mailing Address - Phone:410-665-1990
Mailing Address - Fax:410-665-9980
Practice Address - Street 1:8713 HARFORD RD
Practice Address - Street 2:101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4650
Practice Address - Country:US
Practice Address - Phone:410-665-1990
Practice Address - Fax:410-665-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD014697261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1167FQOtherBCBS
MD4104832OtherAETNA
MD051331800Medicaid
MD04309011OtherUNITED HEALTCARE
MD10075OtherEHP
MD10075OtherEHP
MD4104832OtherAETNA
D01268Medicare UPIN