Provider Demographics
NPI:1265600522
Name:FAHERTY, ELEANOR COURT (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:COURT
Last Name:FAHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELEANOR
Other - Middle Name:MARIE
Other - Last Name:COURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64226
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-7559
Mailing Address - Country:US
Mailing Address - Phone:410-328-7320
Mailing Address - Fax:410-328-5919
Practice Address - Street 1:11340 PEMBROOKE SQ STE 202
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:410-328-7320
Practice Address - Fax:410-328-5919
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74200208600000X
VA0101242982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery