Provider Demographics
NPI:1518228097
Name:FONGONG, GERALDINE L
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:L
Last Name:FONGONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 GLENALLAN AVE
Mailing Address - Street 2:APT# 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3509
Mailing Address - Country:US
Mailing Address - Phone:240-221-3074
Mailing Address - Fax:
Practice Address - Street 1:2201 GLENALLAN AVE
Practice Address - Street 2:APT# 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3509
Practice Address - Country:US
Practice Address - Phone:240-221-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide