Provider Demographics
NPI:1114637584
Name:FONJI, PETER EPAH
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EPAH
Last Name:FONJI
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 1:849 21ST ST NE APT 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4166
Mailing Address - Country:US
Mailing Address - Phone:202-394-0237
Mailing Address - Fax:
Practice Address - Street 1:849 21ST ST NE APT 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4166
Practice Address - Country:US
Practice Address - Phone:202-394-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00193748374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide