MEDICARE: RAYMOND ZAH FONKEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA14489	DC

General Provider Information

NPI Number	:	1053972521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND ZAH FONKEM

Provider Business Mailing Address
First Line	:	2314 BRIGHTSEAT RD APT 002
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-3554
Country	:	US
Telephone Number	:	240-918-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	2314 BRIGHTSEAT RD APT 002
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-3554
Country	:	US
Telephone Number	:	240-918-2235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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