Provider Demographics
NPI:1659831808
Name:FIASORGBOR, EMIL KWABLA
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:KWABLA
Last Name:FIASORGBOR
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 1:700 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2515
Mailing Address - Country:US
Mailing Address - Phone:443-655-9931
Mailing Address - Fax:
Practice Address - Street 1:7067 COLUMBIA GATEWAY DR STE 180
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3408
Practice Address - Country:US
Practice Address - Phone:410-929-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2089762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry