Nicholas Charles Fasano (NPI# 1013932292, PAC ID# 9830194257) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1013932292 |
| PAC ID by PECOS | 9830194257 |
| Professional Enrollment ID | I20060919000004 |
| Full Name | Nicholas Charles Fasano |
| Organization Legal Name | UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS, PA |
| Address |
222 Deer Trail Rd Spring Grove PA 17362-8603 |
| Phone Number | 4103283477 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE |
| Graduation Year | 2001 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 7719873298 |
| Number of Group Practice Members | 75 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140029 | COPLEY MEMORIAL HOSPITAL |
| 210035 | UNIVERSITY OF MD CHARLES REGIONAL MEDICAL CENTER |
| 210003 | UNIVERSITY OF MD PRINCE GEORGE'S HOSPITAL CTR |
| 210002 | UNIVERSITY OF MARYLAND MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 22 S Greene St, Department of Radiology, Baltimore, MD 21201-1544 | 4103285700 | UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS, PA |
| 3001 Hospital Dr, Cheverly, MD 20785-1189 | 3016182000 | UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS, PA |
| 222 Deer Trail Rd, Spring Grove, PA 17362-8603 | 4103283477 | UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS, PA |
| Organization Legal Name | UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS, PA |
| Physicians | 20 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Azar P Dagher | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 7600 Dwight Dr, Bethesda, MD 20817-2027 |
| Kathleen G Gordon | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 7300 Van Dusen Rd, Laurel, MD 20707-9463 |
| Kim M Callwood | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 7300 Van Dusen Rd, Laurel, MD 20707-9463 |
| Matthew Peter Dattwyler | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 5 Garrett Ave, La Plata, MD 20646-5960 |
| Shavitri Ananda Mahendiran | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 3001 Hospital Dr, Cheverly, MD 20785-1189 |
| Charles E Hunter | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 7300 Van Dusen Rd, Laurel, MD 20707-9463 |
| Vasken Dilsizian | Nuclear Medicine | University of Maryland Diagnostic Imaging Specialists, Pa | 5 Garrett Ave, La Plata, MD 20646-5960 |
| Thomas Ptak | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 5 Garrett Ave, La Plata, MD 20646-5960 |
| Ifechi Natalie Ukeh | Interventional Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 3001 Hospital Dr, Cheverly, MD 20785-1189 |
| Thorsten Roger Fleiter | Diagnostic Radiology | University of Maryland Diagnostic Imaging Specialists, Pa | 5 Garrett Ave, La Plata, MD 20646-5960 |
| Street Address |
222 DEER TRAIL RD |
| City | SPRING GROVE |
| State | PA |
| Zip | 17362-8603 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christina Nicole Doll | Family Medicine | Wellspan Medical Group | 430 N Main St, Wellspan Family Medicine Spring Grove, Spring Grove, PA 17362-1123 |
| Jessica Lynn Guinard | Nurse Practitioner | Wellspan Medical Group | 430 N Main St, Wellspan Family Medicine Spring Grove, Spring Grove, PA 17362-1123 |
| Robert C Matylewicz | Family Practice | Main Street Family Medicine of Spring Grove, Inc. | 285 N Main St, Spring Grove, PA 17362-1134 |
| Tracy Prince | Family Medicine | Pinnacle Health Medical Services | 2030 Thistle Hill Dr, Spring Grove, PA 17362-1159 |
| Matthew L Burr | Optometry | 2030 Thistle Hill Dr, Spring Grove, PA 17362-1159 | |
| Howard H Farrington Iii | Family Medicine | 2030 Thistle Hill Dr, Suite 200, Spring Grove, PA 17362-1161 | |
| Christine Denise Holtz | Nurse Practitioner | Spring Grove Family Care Center LLC | 2030 Thistle Hill Dr, Suite 200, Spring Grove, PA 17362-1161 |
| City | SPRING GROVE |
| Zip Code | 17362 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | SPRING GROVE + DIAGNOSTIC RADIOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.