MEDICARE: EMMANUEL ABONGWA FOKOUM

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710847785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL ABONGWA FOKOUM

Provider Business Mailing Address
First Line	:	6021 BERWYN RD
Second Line	:
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2639
Country	:	US
Telephone Number	:	202-560-3123
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 BERWYN RD
Second Line	:
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2639
Country	:	US
Telephone Number	:	202-560-3123
Fax Number	:

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

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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