Provider Demographics
NPI:1104682848
Name:FADIMATOU, VIOLET
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:FADIMATOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 BATTLEMENT CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1633
Mailing Address - Country:US
Mailing Address - Phone:240-579-1770
Mailing Address - Fax:
Practice Address - Street 1:1814 BATTLEMENT CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1633
Practice Address - Country:US
Practice Address - Phone:240-579-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator