Individual
FOTTFAM BAGUIO LABOUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
555 S 43RD ST, PHILADELPHIA, PA 19104-4408
(215) 685-7504
Mailing address
7240 RIDGE AVE, PHILADELPHIA, PA 19128-3203
(209) 598-3180
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA059727
PA
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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