Individual
VYACHESLAV FUZAYLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(667) 214-1616
(410) 328-1674
Mailing address
PO BOX 64374, BALTIMORE, MD 21264-4374
(667) 214-1616
(410) 328-1674
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0060082
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
585501200
—
MD
Enumeration date
11/17/2005
Last updated
11/20/2019
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