Healthcare Provider Details

I. General information

NPI: 1346072378
Provider Name (Legal Business Name): MR. TERENCE AKWEWOH FONCHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 85TH AVE APT 533185TH
NEW CARROLLTON MD
20784-3214
US

IV. Provider business mailing address

9865 GOOD LUCK RD APT 39865
LANHAM MD
20706-3203
US

V. Phone/Fax

Practice location:
  • Phone: 945-333-5100
  • Fax:
Mailing address:
  • Phone: 945-333-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: