Provider Demographics
NPI:1609841642
Name:FADDEN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FADDEN
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:PO BOX 660
Mailing Address - Street 2:301 RANDOLPH ST
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:302 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643
Practice Address - Country:US
Practice Address - Phone:410-943-8763
Practice Address - Fax:410-943-8244
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4533260OtherAETNA
MD521116591OtherMARYLAND PHYSICIANS CARE
MD521116591OtherINFORMED
MD735683OtherNCPPO
MD41332103OtherCAREFIRST BC/BS RENDERING
MD683716OtherCOVENTRY
MD339268OtherMAMSI/ALLIANCE
MD8118232OtherOPTIMUM CHOICE/MDIPA
MDP16368OtherCAREFIRST BC/BS POS
MD6104182OtherCIGNA
MD784381000Medicaid
MDT5880025OtherCF BC/BS GRP/GHMSI/BL CHO
MD031865OtherPRIORITY PARTNERS
MD521116591OtherTRICARE
MDP00140748Medicare PIN
MD735683OtherNCPPO
MDT5880025OtherCF BC/BS GRP/GHMSI/BL CHO