BASIL E FOMANKA

LAUREL, MD
NPI1013621010
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: MD  R198010)
Enumeration Date2023-01-13
Last Update Date2024-06-27
Business Address
BASIL E FOMANKA
14201 OXFORD DR
LAUREL, MD 20707-5855
Phone number: 443-520-8138
Mailing Address
BASIL E FOMANKA
14201 OXFORD DR
LAUREL, MD 20707-5855
Phone number: 443-520-8138
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