Provider Demographics
NPI:1023439676
Name:CHOFOR, BELTUS FUSI
Entity type:Individual
Prefix:
First Name:BELTUS
Middle Name:FUSI
Last Name:CHOFOR
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 1:9712 BALD HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2875
Mailing Address - Country:US
Mailing Address - Phone:240-701-0866
Mailing Address - Fax:
Practice Address - Street 1:9712 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2875
Practice Address - Country:US
Practice Address - Phone:240-701-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9854374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide