Provider Demographics
NPI:1972927978
Name:NKEM, PETER FONCHA
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:FONCHA
Last Name:NKEM
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 1:12230 APACHE TEARS CIR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2847
Mailing Address - Country:US
Mailing Address - Phone:240-640-6219
Mailing Address - Fax:
Practice Address - Street 1:3203 BARCROFT DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2581
Practice Address - Country:US
Practice Address - Phone:240-593-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide