Provider Demographics
NPI:1649397605
Name:TALENTINO, FRED (ATC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:TALENTINO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 BECKETT WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1359
Mailing Address - Country:US
Mailing Address - Phone:410-313-8595
Mailing Address - Fax:
Practice Address - Street 1:12100 WOODFORD DR
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1454
Practice Address - Country:US
Practice Address - Phone:410-313-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer