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NPI Code Detail

MEDICARE: KENNETH A FOMINYEN

MEDICARE: KENNETH A FOMINYEN
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1053678532
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH A FOMINYEN
Provider Business Mailing Address
First Line : 7401 NEW HAMPSHIRE AVE
Second Line : APT# 814
City : TAKOMA PARK
State : MD
Zip : 20912-6945
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7401 NEW HAMPSHIRE AVE
Second Line : APT# 814
City : TAKOMA PARK
State : MD
Zip : 20912-6945
Country : US
Telephone Number : 202-722-1725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2012
Last Update Date : 04/20/2012

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Directions to “ KENNETH A FOMINYEN ” Practice Location

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