Active NPI
Dominic Agwunglefah Fobellah
- Registered Nurse
- Lanham, MD
National Provider Identifier
1669090221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN1058327
- Practice address
- 5644 Whitfield Chapel Rd Apt 202
Lanham, MD 20706-2560 - Phone
- (240) 476-5800
- NPI assigned
- Jul 10, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN1058327 | DC | Primary |
Addresses
Primary practice location
5644 Whitfield Chapel Rd Apt 202
Lanham, MD 20706-2560
Mailing address
5644 Whitfield Chapel Rd Apt 202
Lanham, MD 20706-2560
Phone (240) 476-5800
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 |
|---|---|---|---|
| RN1058327 | DC | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1669090221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5644 WHITFIELD CHAPEL RD APT 202",
"city": "LANHAM",
"state": "MD",
"postal_code": "207062560",
"telephone_number": "240-476-5800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5644 WHITFIELD CHAPEL RD APT 202",
"city": "LANHAM",
"state": "MD",
"postal_code": "207062560",
"telephone_number": "240-476-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGWUNGLEFAH FOBELLAH",
"first_name": "DOMINIC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-10",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "DC",
"license": "RN1058327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lanham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.