Provider Demographics
NPI:1093074601
Name:FOBELLA, ATABONG MORFAW
Entity Type:Individual
Prefix:
First Name:ATABONG
Middle Name:MORFAW
Last Name:FOBELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9134 EDMONSTON CT APT H303
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1526
Mailing Address - Country:US
Mailing Address - Phone:240-413-1237
Mailing Address - Fax:
Practice Address - Street 1:9134 EDMONSTON CT APT H303
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1526
Practice Address - Country:US
Practice Address - Phone:240-413-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS-140-073-609-308374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide