Provider Demographics
NPI:1508231523
Name:TCHATCHOUANG FANMEGNE, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:TCHATCHOUANG FANMEGNE
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 1:7779 RIVERDALE RD
Mailing Address - Street 2:APT 303
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3939
Mailing Address - Country:US
Mailing Address - Phone:202-725-0691
Mailing Address - Fax:
Practice Address - Street 1:7779 RIVERDALE RD
Practice Address - Street 2:APT 303
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3939
Practice Address - Country:US
Practice Address - Phone:202-725-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10503390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA10503Medicaid