Provider Demographics
NPI:1881420537
Name:FOFUNG, PHILIP BAH
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BAH
Last Name:FOFUNG
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 1:1006 ROSEY BILL DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7035
Mailing Address - Country:US
Mailing Address - Phone:240-486-9379
Mailing Address - Fax:
Practice Address - Street 1:1006 ROSEY BILL DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7035
Practice Address - Country:US
Practice Address - Phone:240-486-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide