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Basil E Fomanka, NP
Prescribing (Medical) Psychologist in Laurel, Maryland
NPI 1013621010

Basil E Fomanka is a Prescribing (Medical) Psychologist based in Laurel, MD and is specialized in Prescribing (Medical). Basil E Fomanka practices in Laurel, MD and has the professional credentials of NP. The NPI Number for Basil E Fomanka is 1013621010 and holds a License No. (Maryland).

The current practice location address for Basil E Fomanka is 14201 Oxford Dr, Laurel, MD and can be reached out via phone at 443-520-8138.

Location: 14201 Oxford Dr, Laurel, MD, 20707-5855
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013621010
Provider Name
Basil E Fomanka
Credential
NP
Provider Entity Type
Individual
Gender
Male
Address
14201 Oxford Dr, Laurel, MD, 20707-5855
Phone Number
443-520-8138
Fax Number
Provider Enumeration Date
01/13/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
14201 Oxford Dr
City
Laurel
State
Maryland
Zip
20707-5855
Phone Number
443-520-8138
Fax Number
person
Provider Business Mailing Address Details
Address
14201 Oxford Dr
City
Laurel
State
Maryland
Zip
20707-5855
Phone Number
443-520-8138
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Prescribing (Medical)
Taxonomy
103TP0016X
License No.
()
Definition
A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended.
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