Provider Demographics
NPI:1497118012
Name:FON, ACHU
Entity Type:Individual
Prefix:
First Name:ACHU
Middle Name:
Last Name:FON
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 1:11457 CHERRY HILL RD
Mailing Address - Street 2:APT. 203
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3607
Mailing Address - Country:US
Mailing Address - Phone:832-853-1057
Mailing Address - Fax:
Practice Address - Street 1:11457 CHERRY HILL RD
Practice Address - Street 2:APT. 203
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3607
Practice Address - Country:US
Practice Address - Phone:832-853-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11919374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide