Provider Demographics
NPI:1902127574
Name:FADGEN, CHRISTIAN (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:FADGEN
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 BACK POINTE CT UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2574
Mailing Address - Country:US
Mailing Address - Phone:410-941-9695
Mailing Address - Fax:
Practice Address - Street 1:139 N MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-8808
Practice Address - Country:US
Practice Address - Phone:410-941-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01706171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist