Provider Demographics
NPI:1386773695
Name:FARE, TODD EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:EUGENE
Last Name:FARE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537D BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3809
Mailing Address - Country:US
Mailing Address - Phone:410-544-8444
Mailing Address - Fax:410-544-7941
Practice Address - Street 1:537D BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-544-8444
Practice Address - Fax:410-544-7941
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM612FAOtherCARE FIRST BCBS
MDM612FAOtherCARE FIRST BCBS
MD233RMedicare ID - Type Unspecified