| Organization Name: | MAFOT &ASSOCIATES MEDICAL SERVICES LLC |
| NPI Number: | 1104248541 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAGOBERT SIMO (DIRECTOR) |
| Mailing Address: | 1403 Madison Park Dr Ste 200 Glen Burnie |
| State: | MD US |
| Postal Code: | 210616427 |
| Phone Number: | 4104876902 |
| Fax Number: | 4104876982 |
| NPI Enumeration Date: | 01/18/2014 |
| NPI Last Update Date: | 05/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | D0073466 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |