Provider Demographics
NPI:1700179363
Name:FANOUS, ANDREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:FANOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:1500 N BEAUREGARD ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1715
Practice Address - Country:US
Practice Address - Phone:571-472-4100
Practice Address - Fax:571-472-4101
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0059437207T00000X
CO00594372084N0400X
VA0101264652207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology