Individual
NKANGU KENNETH FOMENGIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9000 WOODYARD RD, CLINTON, MD 20735-4206
(240) 546-3428
(240) 546-3429
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C0006385
MD
Other
Enumeration date
10/31/2014
Last updated
06/18/2021
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