Provider Demographics
NPI:1831787761
Name:MARY CHRISTY KAHMA FOHTUNG, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:MARY CHRISTY KAHMA FOHTUNG
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 1:5600 WHITFIELD CHAPEL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2541
Mailing Address - Country:US
Mailing Address - Phone:240-468-8841
Mailing Address - Fax:
Practice Address - Street 1:5600 WHITFIELD CHAPEL RD APT 101
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2541
Practice Address - Country:US
Practice Address - Phone:240-468-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00191355Medicaid