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General NPI Number Information
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NPI Number | 1548963838
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Entity Type | Individual
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Provider Name | MARIYAMA FOFANA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 1200 BRASS MILL RD
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City | BELCAMP
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State | MD
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Zip | 21017-1217
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Country | US
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Telephone | 443-900-3027
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N JUNIATA ST UNIT 894
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 202203
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License Number State | CA
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