Provider Demographics
NPI:1922215607
Name:WUBU, FASIL M (MD,)
Entity Type:Individual
Prefix:DR
First Name:FASIL
Middle Name:M
Last Name:WUBU
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 GOOD LUCK RD
Mailing Address - Street 2:APT # 5
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3221
Mailing Address - Country:US
Mailing Address - Phone:301-794-0008
Mailing Address - Fax:
Practice Address - Street 1:954 FORREST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4236
Practice Address - Country:US
Practice Address - Phone:410-837-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064695208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist