Active NPI
Patrick Fonge
- Pharmacist
- Bowie, MD
National Provider Identifier
1780081372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH033470.
- Practice address
- 4203 Windflower Way
Bowie, MD 20720 - Phone
- (404) 509-1243
- NPI assigned
- Nov 25, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | HHA10649 | DC | |
| Home Health Aide | 374U00000X | HHA10649 | DC | |
| Pharmacist | 183500000X | RPH033470. | GA | Primary |
Addresses
Primary practice location
4203 Windflower Way
Bowie, MD 20720
Mailing address
7893 Sunvalley LN
Lithia Springs, GA 30122-7816
Phone (404) 509-1243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH033470 | Other | GA | BOARD OF PHARMACY |
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 |
|---|---|---|---|
| RPH033470. | GA | MD | Pharmacist |
| HHA10649 | DC | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639440000000",
"number": "1780081372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7893 SUNVALLEY LN",
"city": "LITHIA SPRINGS",
"state": "GA",
"postal_code": "301227816",
"telephone_number": "404-509-1243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4203 WINDFLOWER WAY",
"city": "BOWIE",
"state": "MD",
"postal_code": "20720",
"telephone_number": "404-509-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONGE",
"first_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-25",
"last_updated": "2021-12-14",
"certification_date": "2021-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "DC",
"license": "HHA10649",
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "DC",
"license": "HHA10649",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH033470.",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY",
"identifier": "RPH033470",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.