Individual
CHARLES FONGOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5614 MALVERN WAY, CAPITOL HEIGHTS, MD 20743-3051
(443) 366-0957
Mailing address
5614 MALVERN WAY, CAPITOL HEIGHTS, MD 20743-3051
(443) 366-0957
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
376K00000X
Nurse's Aide
A00197241
MD
Other
Enumeration date
09/22/2021
Last updated
08/08/2024
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