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General NPI Number Information
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NPI Number | 1811263122
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Entity Type | Individual
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Provider Name | MANUEL SOTO-FOURNIER MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 7253 AMBASSADOR RD
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City | BALTIMORE
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State | MD
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Zip | 21244
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Country | US
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Telephone | 443-436-1221
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Fax | 443-436-1256
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Provider Business Mailing Address
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Address Line | 7253 AMBASSADOR RD
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City | BALTIMORE
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State | MD
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Zip | 21244-2710
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Country | US
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Telephone | 443-436-1221
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Fax | 443-436-1256
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | D83030
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D0083030
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License Number State | MD
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