Healthcare Provider Details

I. General information

NPI: 1982163697
Provider Name (Legal Business Name): EDWARD NDANGOU FONCHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3079 SCHUBERT DR
SILVER SPRING MD
20904-6837
US

IV. Provider business mailing address

3079 SCHUBERT DR
SILVER SPRING MD
20904-6837
US

V. Phone/Fax

Practice location:
  • Phone: 702-353-2600
  • Fax:
Mailing address:
  • Phone: 702-353-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14247
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: