MEDICARE: CHANTAL N FOKOM

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

General Provider Information

NPI Number	:	1811681398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTAL N FOKOM

Provider Business Mailing Address
First Line	:	9743 GOOD LUCK RD APT 8
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3321
Country	:	US
Telephone Number	:	202-415-5369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5614
Country	:	US
Telephone Number	:	202-836-4841
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	10/18/2023

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