Healthcare Provider Details

I. General information

NPI: 1891058103
Provider Name (Legal Business Name): EMMANUEL CHO FRU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 FORBES BLVD
LANHAM MD
20706-2161
US

IV. Provider business mailing address

6907 FORBES BOULEVARD
LANHAM DC
20706
US

V. Phone/Fax

Practice location:
  • Phone: 240-468-4141
  • Fax:
Mailing address:
  • Phone: 240-468-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberAHI10385
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: