Provider Demographics
NPI:1992490882
Name:FONVILLE, DAMIEN
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:
Last Name:FONVILLE
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 1:3708 DIANNA RD
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2226
Mailing Address - Country:US
Mailing Address - Phone:202-925-7300
Mailing Address - Fax:
Practice Address - Street 1:450 TAYLOR ST NE APT 22F
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4332
Practice Address - Country:US
Practice Address - Phone:202-812-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant