Provider Demographics
NPI:1205195815
Name:FORKA, ROMANUS
Entity Type:Individual
Prefix:
First Name:ROMANUS
Middle Name:
Last Name:FORKA
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 1:8812 GLENVILLE RD
Mailing Address - Street 2:APT 2
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3868
Mailing Address - Country:US
Mailing Address - Phone:240-551-1363
Mailing Address - Fax:
Practice Address - Street 1:8812 GLENVILLE RD
Practice Address - Street 2:APT 2
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3868
Practice Address - Country:US
Practice Address - Phone:240-551-1363
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
MDF-620-744-013-394374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide