MEDICARE: LUCAS MBAKWA FONCHAM

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
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1134891633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS MBAKWA FONCHAM

Provider Business Mailing Address
First Line	:	780 FAIRVIEW AVE APT 605
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-5951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 FAIRVIEW AVE APT 605
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-5951
Country	:	US
Telephone Number	:	202-779-2523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2021
Last Update Date	:	03/17/2026

Similar Medicare Providers

1619651262 — WOSENE TIKUYE G EYESSUS
Practice Location Address:

780 FAIRVIEW AVE APT 605
TAKOMA PARK, MD
20912-5951

Practice Phone: 301-825-6312
Practice Fax:

1144355892 — MARTIN E MCGONAGLE MD PA
Practice Location Address:

107 S PARK DR
BROWNWOOD, TX
76801-5951

Practice Phone: 325-643-5824
Practice Fax: 325-643-1256

1811143456 — MRS. MARJORIE GALVIN BOOTH PT
Practice Location Address:

6531 LANDMARK DR , STE E
PARK CITY, UT
84098-5951

Practice Phone: 435-649-7335
Practice Fax: 435-649-7568

1215480207 — MGM THERAPY & BEHAVIORAL TREATMENT CORPORATION
Practice Location Address:

12856 S PAULINA ST
CALUMET PARK, IL
60827-5951

Practice Phone: 708-724-5898
Practice Fax:

1659210847 — HAYAT ABDI ADEM
Practice Location Address:

7777 MAPLE AVE APT 405
TAKOMA PARK, MD
20912-5642

Practice Phone: 301-664-0079
Practice Fax:

1184571242 — ANDRE TIEMENI
Practice Location Address:

6731NEW HAMPSHIRE AVE
TAKOMA PARK, MD
20912

Practice Phone: 240-606-1633
Practice Fax:

Directions to “ LUCAS MBAKWA FONCHAM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.