Provider Demographics
NPI:1346609419
Name:FOTSA, PRICHADO ROMARIC
Entity Type:Individual
Prefix:
First Name:PRICHADO ROMARIC
Middle Name:
Last Name:FOTSA
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 1:3346 TEAGARDEN CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7577
Mailing Address - Country:US
Mailing Address - Phone:301-675-0356
Mailing Address - Fax:
Practice Address - Street 1:3346 TEAGARDEN CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7576
Practice Address - Country:US
Practice Address - Phone:301-675-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health