MEDICARE: PAMELA LESIGA FORKUSAM

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	HHA14059	DC

General Provider Information

NPI Number	:	1295203867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LESIGA FORKUSAM

Provider Business Mailing Address
First Line	:	6731 NEW HAMPSHIRE AVE APT 305
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 ORCHARD AVE STE 301
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4712
Country	:	US
Telephone Number	:	301-758-6588
Fax Number	:

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

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	07/02/2026

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