Individual
MONICK FANBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2502 MOORES PLAINS BLVD, UPPER MARLBORO, MD 20774-8027
(240) 510-5218
Mailing address
2502 MOORES PLAINS BLVD, UPPER MARLBORO, MD 20774-8027
(240) 510-5218
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0005761
MD
Other
Enumeration date
06/16/2015
Last updated
06/16/2015
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