BENJAMIN DALE FORTSON

ROCKVILLE, MD
NPI1497296537
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224P00000X Prosthetist
(Licence: DE  CPO04027)
Additional Taxonomies222Z00000X 
(Licence: DE  CO005694)
Enumeration Date2017-03-08
Last Update Date2018-04-24
Business Address
Mr. BENJAMIN DALE FORTSON MPO, CPO
15200 SHADY GROVE RD STE 102
ROCKVILLE, MD 20850-3218
Phone number: 240-261-4229
Mailing Address
Mr. BENJAMIN DALE FORTSON MPO, CPO
15200 SHADY GROVE RD STE 102
ROCKVILLE, MD 20850-3218
Phone number: 240-261-4229