Individual provider Active NPI

Mudoh Lambert Fongang

  • Community/Behavioral Health Agency
  • Washington, DC
National Provider Identifier
1902276397
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Practice address
2811 Pennsylvania Ave SE
Washington, DC 20020-3865
Phone
(202) 894-6811
NPI assigned
Sep 29, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2811 Pennsylvania Ave SE
Washington, DC 20020-3865

Mailing address

2907 Lake Forest Dr
Upper Marlboro, MD 20774-8972
Phone (240) 486-5785

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

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1902276397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2907 LAKE FOREST DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207748972",
            "telephone_number": "240-486-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 PENNSYLVANIA AVE SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200203865",
            "telephone_number": "202-894-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONGANG",
        "first_name": "MUDOH LAMBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-29",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.