Provider Demographics
NPI:1215135561
Name:FOFIE, ANITA ESTELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ESTELLE
Last Name:FOFIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:AFUA
Other - Last Name:FOFIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2415 WESTERN AVE
Mailing Address - Street 2:APT #503
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1394
Mailing Address - Country:US
Mailing Address - Phone:206-225-8875
Mailing Address - Fax:206-443-6599
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4379
Practice Address - Country:US
Practice Address - Phone:206-386-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20009130208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery