BASIL E FOMANKA

RIVERDALE, MD
NPI1013621010
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: MD  R198010)
Enumeration Date2023-01-13
Last Update Date2025-09-18
Business Address
-- BASIL E FOMANKA
6200 BALTIMORE AVE 300-R9
RIVERDALE, MD 20737-1054
Phone number: 443-520-8138
Mailing Address
-- BASIL E FOMANKA
6200 BALTIMORE AVE STE 300-R9
RIVERDALE, MD 20737-1054
Phone number: 443-520-8138
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