MEDICARE: JUDITH NFONGANG

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1598287633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH NFONGANG

Provider Business Mailing Address
First Line	:	7869 RIVERDALE RD
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4037
Country	:	US
Telephone Number	:	124-091-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5615
Country	:	US
Telephone Number	:	240-917-4310
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/24/2023

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