Provider Demographics
NPI:1407435050
Name:FONGWEN, CLAUDIA WUBNYONGA
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:WUBNYONGA
Last Name:FONGWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESEARCH CT STE 450
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6252
Mailing Address - Country:US
Mailing Address - Phone:240-355-0051
Mailing Address - Fax:
Practice Address - Street 1:1 RESEARCH CT STE 450
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6252
Practice Address - Country:US
Practice Address - Phone:240-355-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217266171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator