Provider Demographics
NPI:1497069249
Name:EMMANUEL, ANTHONY FAUGERES
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FAUGERES
Last Name:EMMANUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 LEATHERFERN TER
Mailing Address - Street 2:APT 101
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-6330
Mailing Address - Country:US
Mailing Address - Phone:301-642-1304
Mailing Address - Fax:
Practice Address - Street 1:6400 GOLDSBORO ROAD SUITE 400
Practice Address - Street 2:MASSACHUSETTS AVE SURGERY CENTER
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-263-0800
Practice Address - Fax:301-263-8020
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACERTIFIED ASSISTANT363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical