Healthcare Provider Details

I. General information

NPI: 1043072259
Provider Name (Legal Business Name): CELINE FOTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4690 MILLENNIUM DR STE 300
BELCAMP MD
21017-1527
US

IV. Provider business mailing address

1101 STOURHEAD CT
ABINGDON MD
21009-1075
US

V. Phone/Fax

Practice location:
  • Phone: 443-469-4593
  • Fax: 479-935-8316
Mailing address:
  • Phone: 443-469-4593
  • Fax: 479-935-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR223546
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: