Provider Demographics
NPI:1992857015
Name:FIDANZA, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:FIDANZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1211
Mailing Address - Country:US
Mailing Address - Phone:410-266-9000
Mailing Address - Fax:410-266-9058
Practice Address - Street 1:2770 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1211
Practice Address - Country:US
Practice Address - Phone:410-266-9000
Practice Address - Fax:410-266-9058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41349001Other2
MDR068001Other1
MD41349001Other2
MDT77210Medicare UPIN