Healthcare Provider Details

I. General information

NPI: 1376336768
Provider Name (Legal Business Name): BODWIN TAMBONGHO FONJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EASTERN AVE NE
WASHINGTON DC
20019-2833
US

IV. Provider business mailing address

1506 FAIRLAKES PL
BOWIE MD
20721-3102
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-1356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005604
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: