| Doctor Name: | DR. ANTOINE KOFI FOMUFOD |
| NPI Number: | 1154372274 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | D16239 |
| Business Practice Address: | 3001 Hospital Dr Pediatrix Medical Group Cheverly, MD - 207851189 |
| Business Phone Number: | 3016182630 |
| Business Fax Number: | 3016183941 |
| Mailing Address: | 5722 Avery Park Dr, ROCKVILLE |
| State: | MD |
| Postal Code: | 208551738 |
| Phone Number: | 3016182630 |
| Fax Number: | 3016183941 |
| NPI Enumeration Date: | 05/13/2006 |
| NPI Last Update Date: | 07/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080N0001X |
| License Number: | D16239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Neonatal-Perinatal Medicine |
| Taxonomy Definition: | A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |