Provider Demographics
NPI:1558588830
Name:TCHANQUE-FOSSUO, CATHERINE NDJEUKAM (MD, MS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:NDJEUKAM
Last Name:TCHANQUE-FOSSUO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 MONTGOMERY NE BLDG 1 ST A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3670
Mailing Address - Country:US
Mailing Address - Phone:505-273-5054
Mailing Address - Fax:505-855-5533
Practice Address - Street 1:10151 MONTGOMERY BLVD NE BLDG 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3670
Practice Address - Country:US
Practice Address - Phone:505-273-5054
Practice Address - Fax:505-855-5533
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0742207ND0101X, 207N00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology