Most Relevant Information
Provider Data
| NPI Number: | 1003394255 |
| Provider Name: | BOSEDE FATUSIN |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/31/2018 |
| Last Updated: | 07/31/2018 |
Provider Practice Location
1799 SEA PINE CIR
SEVERN
MD
211441144
Practice Location Phone/Fax
| Phone: | 2405659374 |
| Fax: |
Provider Mailing Location
1799 SEA PINE CIR
SEVERN
MD
211441144
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |