Provider Demographics
NPI:1235488610
Name:FOLEFAC, DAVID NTIZEAH
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NTIZEAH
Last Name:FOLEFAC
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 1:3409 LADOVA WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2524
Mailing Address - Country:US
Mailing Address - Phone:240-899-0785
Mailing Address - Fax:
Practice Address - Street 1:3409 LADOVA WAY
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-2524
Practice Address - Country:US
Practice Address - Phone:240-899-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide