Healthcare Provider Details

I. General information

NPI: 1134354269
Provider Name (Legal Business Name): BINETOU SYLLA FALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 KNOLL NORTH DR SUITE 370
COLUMBIA MD
21045-2370
US

IV. Provider business mailing address

5500 KNOLL NORTH DR SUITE 370
COLUMBIA MD
21045-2370
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-7831
  • Fax: 410-740-2955
Mailing address:
  • Phone: 410-884-7831
  • Fax: 410-740-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0074463
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: