Organization
FULERA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDDRISU TIA (OWNER)
(301) 793-8201
Entity
Organization
Contact information
Practice address
4108 MAINE AVE, BALTIMORE, MD 21207-7503
(301) 793-8201
Mailing address
4108 MAINE AVE, BALTIMORE, MD 21207-7503
(301) 793-8201
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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