Provider Demographics
NPI:1679754360
Name:MASSIMO S FIANDACA MD PA
Entity Type:Organization
Organization Name:MASSIMO S FIANDACA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSIMO
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:FIANDACA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-925-8526
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY #209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-772-3685
Mailing Address - Fax:410-772-3686
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY # 209
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-772-3685
Practice Address - Fax:410-772-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41956207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD177PMedicare PIN