Individual provider Active NPI

Vincent Dufour Fouedjou, FNP

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1093537607
Registry record updated Oct 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R207919 Issued in MD
Practice address
6901 Security Blvd
Baltimore, MD 21244-2412
Phone
(410) 837-2050
NPI assigned
Oct 26, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R207919 MD Primary

Addresses

Primary practice location

6901 Security Blvd
Baltimore, MD 21244-2412

Mailing address

11401 Sunny Hill CT
Hagerstown, MD 21742-3246
Phone (240) 491-1575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260121001967 MD Practitioner - Nurse Practitioner 7911484977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Privia Care Center LLCGroup PAC ID 3274801139, 286 clinicians

Practice addresses (Care Compare)

1050 Key Pkwy
Suite 102
Frederick, MD 21702-4496
Phone (240) 215-1138

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R207919MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Menocal Medical Services PA Current Accepting new patients
Privia Care Center LLC CurrentSince Dec 11, 2025 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Privia Care Center LLC Past Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138

13204 Fountain Head Plz
Hagerstown, MD 21742
Phone (240) 215-1138

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: vincent.fouedjou.1@8042.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729900800000",
    "number": "1093537607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11401 SUNNY HILL CT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217423246",
            "telephone_number": "240-491-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 SECURITY BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212442412",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUEDJOU",
        "first_name": "VINCENT",
        "middle_name": "DUFOUR",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-26",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R207919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.