Active NPI
Charles Fongoh
- Case Manager/Care Coordinator
- Capitol Heights, MD
National Provider Identifier
1073284808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 5614 Malvern Way
Capitol Heights, MD 20743-3051 - Phone
- (443) 366-0957
- NPI assigned
- Sep 22, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | A00197241 | MD | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
5614 Malvern Way
Capitol Heights, MD 20743-3051
Mailing address
5614 Malvern Way
Capitol Heights, MD 20743-3051
Phone (443) 366-0957
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A00197241 | MD | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1073284808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5614 MALVERN WAY",
"city": "CAPITOL HEIGHTS",
"state": "MD",
"postal_code": "207433051",
"telephone_number": "443-366-0957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5614 MALVERN WAY",
"city": "CAPITOL HEIGHTS",
"state": "MD",
"postal_code": "207433051",
"telephone_number": "443-366-0957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONGOH",
"first_name": "CHARLES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-22",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "MD",
"license": "A00197241",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Capitol Heights, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.