Provider Demographics
NPI:1538770599
Name:FOTSO, SAMUELA
Entity type:Individual
Prefix:MS
First Name:SAMUELA
Middle Name:
Last Name:FOTSO
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 1:11700 OLD COLUMBIA PIKE APT 803
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2554
Mailing Address - Country:US
Mailing Address - Phone:202-823-7308
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2579
Practice Address - Country:US
Practice Address - Phone:202-823-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant