Provider Demographics
NPI:1588241459
Name:FONTJE, CHAMU B
Entity type:Individual
Prefix:
First Name:CHAMU
Middle Name:B
Last Name:FONTJE
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 1:2400 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3616
Mailing Address - Country:US
Mailing Address - Phone:301-675-3319
Mailing Address - Fax:
Practice Address - Street 1:2400 QUEENS CHAPEL RD APT 7
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3631
Practice Address - Country:US
Practice Address - Phone:301-675-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide