Provider Demographics
NPI:1942553698
Name:FONGUE FONGUE, SAMUEL FLORIAN (HHA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:FLORIAN
Last Name:FONGUE FONGUE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 TREETOP LN APT 13
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6619
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:202-545-0935
Practice Address - Street 1:1901 TREETOP LN APT 13
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6619
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0935
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide