Provider Demographics
NPI:1578865044
Name:FEIJOO, ADRIAN ALONSO (PAC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ALONSO
Last Name:FEIJOO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 N WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3128
Mailing Address - Country:US
Mailing Address - Phone:410-374-9391
Mailing Address - Fax:
Practice Address - Street 1:4231 N WOODS TRL
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-3128
Practice Address - Country:US
Practice Address - Phone:410-374-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC04409OtherLICENSE NUMBER