Provider Demographics
NPI:1407638554
Name:FODOUOP, CHRISTINE KENMOGNE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KENMOGNE
Last Name:FODOUOP
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 1:2303 COLUMBIA PL
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4919
Mailing Address - Country:US
Mailing Address - Phone:301-806-3750
Mailing Address - Fax:
Practice Address - Street 1:2303 COLUMBIA PL
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4919
Practice Address - Country:US
Practice Address - Phone:301-806-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator