Provider Demographics
NPI:1316277551
Name:FOOKSMAN, BELLA (MAC)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:FOOKSMAN
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 GREENSPRING VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4136
Mailing Address - Country:US
Mailing Address - Phone:410-654-8997
Mailing Address - Fax:410-654-8449
Practice Address - Street 1:8 GREENSPRING VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4136
Practice Address - Country:US
Practice Address - Phone:410-654-8997
Practice Address - Fax:410-654-8449
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist