Provider Demographics
NPI:1346072378
Name:FONCHAM, TERENCE AKWEWOH
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:AKWEWOH
Last Name:FONCHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9865 GOOD LUCK RD APT 39865
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3203
Mailing Address - Country:US
Mailing Address - Phone:945-333-5100
Mailing Address - Fax:
Practice Address - Street 1:5331 85TH AVE APT 533185TH
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3214
Practice Address - Country:US
Practice Address - Phone:945-333-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator