Provider Demographics
NPI:1427779560
Name:FATUROTI, DORIS DOLAPO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:DOLAPO
Last Name:FATUROTI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 WAESCHE PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2262
Mailing Address - Country:US
Mailing Address - Phone:301-728-4439
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:240-401-5270
Practice Address - Fax:443-594-2112
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164383207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine