Provider Demographics
NPI:1316500499
Name:SANTOS, FABIUS ABELARD
Entity type:Individual
Prefix:
First Name:FABIUS
Middle Name:ABELARD
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 CORPORATE DR STE C
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4917
Mailing Address - Country:US
Mailing Address - Phone:410-505-7952
Mailing Address - Fax:410-701-3845
Practice Address - Street 1:8019 CORPORATE DR STE C
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4917
Practice Address - Country:US
Practice Address - Phone:410-505-7952
Practice Address - Fax:410-701-3845
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212233363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health