Provider Demographics
NPI:1184610032
Name:FOSSETT, DAMIREZ TORUVIO (MD)
Entity type:Individual
Prefix:
First Name:DAMIREZ
Middle Name:TORUVIO
Last Name:FOSSETT
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 1:2041 GEORGIA AVE NW # 5B05
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-1546
Mailing Address - Fax:202-865-4395
Practice Address - Street 1:2041 GEORGIA AVE NW # 5B05
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-1546
Practice Address - Fax:202-865-4395
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50791207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215512501Medicaid
MD215512501Medicaid