Individual
DR. LUIS M FANDOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W MAIN ST, SUITE 116, BABYLON, NY 11702
(631) 422-6166
(631) 422-6266
Mailing address
11350 MCCORMICK RD, EXECUTIVE PLAZA 1, SUITE 501, HUNT VALLEY, MD 21031
(410) 329-1071
(410) 329-1054
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
208260
NY
208VP0014X
Interventional Pain Medicine Physician
Primary
208260
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01793255
—
NY
Enumeration date
07/01/2006
Last updated
06/18/2021
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