Individual
DR. MICHAEL ANTHONY FAVATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
C2-0005222
DE
Other
Enumeration date
02/14/2006
Last updated
09/05/2012
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