Provider Demographics
NPI:1851504237
Name:DEL FAVERO, DEAN NATALE (IDC)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:NATALE
Last Name:DEL FAVERO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 STUMP NECK RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-3681
Mailing Address - Country:US
Mailing Address - Phone:301-744-6875
Mailing Address - Fax:
Practice Address - Street 1:2008 STUMP NECK RD
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-3681
Practice Address - Country:US
Practice Address - Phone:301-744-6875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman