Individual provider · NPI-1

Dr. Luis M Fandos, M.D.

Pain Medicine, Interventional Pain Medicine · Babylon, NY

NPI number1376572594
StatusActive
Last updated in NPPESJun 18, 2021

Details

NPI
1376572594
Entity type
Individual (NPI-1)
Name
Dr. Luis M Fandos
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Jul 1, 2006
Certification date
Jun 18, 2021
Last updated
Jun 18, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208VP0014X Pain Medicine, Interventional Pain Medicine208260NYYes
207LP2900X Anesthesiology, Pain Medicine208260NY

Practice location

500 W Main St
Suite 116
Babylon, NY 11702

Phone 631-422-6166 · Fax 631-422-6266

Mailing address

11350 Mccormick Rd
Executive Plaza 1, Suite 501
Hunt Valley, MD 21031

Phone 410-329-1071 · Fax 410-329-1054

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