Provider Demographics
NPI:1104994458
Name:ENGSTROM, FAYETTE MARSH (MD)
Entity type:Individual
Prefix:DR
First Name:FAYETTE
Middle Name:MARSH
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42 LONDONDERRY DR.
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2536
Mailing Address - Country:US
Mailing Address - Phone:410-822-6793
Mailing Address - Fax:410-822-6793
Practice Address - Street 1:42 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2536
Practice Address - Country:US
Practice Address - Phone:410-822-6793
Practice Address - Fax:410-822-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD41160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics