Provider Demographics
NPI:1659420990
Name:FAHEY, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:FAHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIV OF MD HEALTH CTR
Mailing Address - Street 2:CAMPUS DRIVE, BLDG. 140
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-0001
Mailing Address - Country:US
Mailing Address - Phone:301-314-8145
Mailing Address - Fax:301-405-9755
Practice Address - Street 1:UNIV OF MD HEALTH CTR
Practice Address - Street 2:CAMPUS DRIVE, BLDG. 140
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-314-8145
Practice Address - Fax:301-405-9755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD26478204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine