Provider Demographics
NPI:1427749985
Name:FULE MARTHA, BWANG
Entity type:Individual
Prefix:
First Name:BWANG
Middle Name:
Last Name:FULE MARTHA
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 1:14723 RING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-2042
Mailing Address - Country:US
Mailing Address - Phone:360-499-1307
Mailing Address - Fax:
Practice Address - Street 1:1800 METZEROTT RD APT 307
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5104
Practice Address - Country:US
Practice Address - Phone:360-499-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health