Provider Demographics
NPI:1902456502
Name:DIAWARA, FOUSSEYNI M
Entity Type:Individual
Prefix:MR
First Name:FOUSSEYNI
Middle Name:M
Last Name:DIAWARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 E GUDE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1372
Mailing Address - Country:US
Mailing Address - Phone:301-339-4217
Mailing Address - Fax:240-863-3007
Practice Address - Street 1:1680 E GUDE DR STE 302
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-605-5572
Practice Address - Fax:240-863-3007
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1014932471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty