Provider Demographics
NPI:1245862705
Name:DELOSSANTOS, FIDES L (RRT)
Entity type:Individual
Prefix:
First Name:FIDES
Middle Name:L
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SCOTTISH ISLE CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3081
Mailing Address - Country:US
Mailing Address - Phone:443-799-5187
Mailing Address - Fax:
Practice Address - Street 1:1905 SCOTTISH ISLE CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-3081
Practice Address - Country:US
Practice Address - Phone:443-799-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL06460227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered