Provider Demographics
NPI:1134486194
Name:FONGE, THOMAS NKENGATEH
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NKENGATEH
Last Name:FONGE
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 1:7709 RIVERDALE RD
Mailing Address - Street 2:APT 102
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3941
Mailing Address - Country:US
Mailing Address - Phone:240-640-7673
Mailing Address - Fax:
Practice Address - Street 1:7709 RIVERDALE RD
Practice Address - Street 2:APT 102
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3941
Practice Address - Country:US
Practice Address - Phone:240-640-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide