Provider Demographics
NPI:1154372274
Name:FOMUFOD, ANTOINE KOFI (MD)
Entity type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:KOFI
Last Name:FOMUFOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:FOMUFOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5722 AVERY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1738
Mailing Address - Country:US
Mailing Address - Phone:301-618-2630
Mailing Address - Fax:301-618-3941
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:PEDIATRIX MEDICAL GROUP
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:301-618-2630
Practice Address - Fax:301-618-3941
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD162392080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine