MR. BENJAMIN DALE FORTSON (NPI# 1497296537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497296537 |
| Entity Type | Individual |
| Full Name | MR. BENJAMIN DALE FORTSON |
| Credential | MPO, CPO |
| Practice Address |
15200 Shady Grove Rd Ste 102 Rockville MD 20850-3218 |
| Practice Telephone | 2402614229 |
| Practice Fax Number | 2402614489 |
| Mailing Telephone | 2402614229 |
| Mailing Fax Number | 2402614489 |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2018-04-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | CO005694 | DE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 224P00000X | Prosthetist | CPO04027 | DE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 73 Thomas Johnson Dr Ste B, Frederick, MD 217024426 | 3016984692 | 3016984693 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063945756 | Benjamin Leonard Fortson | Student in an Organized Health Care Education/Training Program | 3300 Nw Expressway, Oklahoma City, OK 73112 | 2017-04-10 |
| Street Address |
15200 SHADY GROVE RD STE 102 |
| City | ROCKVILLE |
| State | MD |
| Zip Code | 20850-3218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801384052 | Kristen Elizabeth Desjardins | Orthotist | 15200 Shady Grove Rd Ste 102, Rockville, MD 20850-3218 | 2018-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487286050 | Um Fdsp Associates, P.a. | Dentist | 9631 Gudelsky Drive, Suite 2135, Rockville, MD 20850 | 2020-02-11 |
| 1134767874 | Bh Brightview Fallsgrove Opco, LLC | Alzheimer Center (Dementia Center) | 9200 Darnestown Road, Rockville, MD 20850 | 2019-12-12 |
| 1750924205 | Omer N Pamuk | Internal Medicine | 9000 Rockville Pike, Building 10, Room 10n-311, Rockville, MD 20850 | 2019-10-28 |
| 1902456502 | Fousseyni M Diawara | Radiologic Technologist | 1680 E Gude Dr Ste 302, Rockville, MD 20850 | 2019-09-16 |
| 1104485697 | Barbara S Delsack | Speech-Language Pathologist | Montgomery County Public Schools, 850 Hungerford Drive, Rockville, MD 20850 | 2019-06-10 |
| 1982178158 | Larissa Woloszyn | Behavioral Analyst | 15425 Shady Grove, Suite 320, Rockville, MD 20850 | 2019-01-21 |
| 1417421843 | Wei Li | Acupuncturist | 9600 Blackwell Road. Suite 300, Rockville, MD 20850 | 2019-01-18 |
| 1881168805 | Heather Jean Scurtu Mann | Psychologist | Quince Orchard Psychotherapy, 9707 Key West Avenue, Suite 100, Rockville, MD 20850 | 2019-01-12 |
| 1295208486 | Laura Hanley | Physical Therapy Assistant | The Village At Rockville, Functional Pathways, 9701 Veirs Drive, Rockville, MD 20850 | 2019-01-10 |
| 1538641964 | Shamire Pierre-louis | Speech-Language Pathologist | 2 Research Place, Rockville, MD 20850 | 2018-09-01 |
| Find all providers in zip 20850 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447866074 | Rosetta Randolph | Prosthetist | 15 Wytchwood Ct Apt T1, Baltimore, MD 21209-4832 | 2020-09-18 |
| 1619597408 | Tationia Bowen | Prosthetist | 3016 Westfield Ave, Baltimore, MD 21214-1433 | 2020-04-21 |
| 1437783214 | Salena Rosa | Prosthetist | 4526 Beech Rd, Temple Hills, MD 20748-6704 | 2020-03-02 |
| 1619517851 | Kierra Royster | Prosthetist | 6957 Aquamarine Ct, Capitol Heights, MD 20743-1879 | 2020-01-15 |
| 1548823222 | Roger Hamilton | Prosthetist | 10903 Indian Head Hwy Ste 312, Fort Washington, MD 20744-4005 | 2019-04-17 |
| 1154898732 | Niokie Laws | Prosthetist | 216 Crain Hwy N Ste 202a, Glen Burnie, MD 21061-3085 | 2018-11-01 |
| 1942791421 | Uniquely Urs Hair Restoration Center | Prosthetist | 1144 Smallwood Dr W # E1, Waldorf, MD 20603-4759 | 2018-05-21 |
| 1528569241 | Delphine Gathoni Njuguna | Prosthetist | 4509 Blackbirds Folly Ln, Bowie, MD 20720-5803 | 2018-02-27 |
| 1841706173 | Afa Orthotics and Prosthetics LLC | Prosthetist | 2086 Generals Hwy Ste 305, Annapolis, MD 21401-6759 | 2017-12-22 |
| 1548701402 | Todd John Sleeman | Prosthetist | 10515 Calumet Dr, Silver Spring, MD 20901-4607 | 2017-03-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.