Individual
MR. BENJAMIN DALE FORTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPO, CPO
Contact information
Practice address
15200 SHADY GROVE RD STE 102, ROCKVILLE, MD 20850-3218
(240) 261-4229
(240) 261-4489
Mailing address
15200 SHADY GROVE RD STE 102, ROCKVILLE, MD 20850-3218
(240) 261-4229
(240) 261-4489
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CO005694
DE
224P00000X
Prosthetist
Primary
CPO04027
DE
Other
Enumeration date
03/08/2017
Last updated
04/24/2018
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