Provider Demographics
NPI:1861212250
Name:FOPPA, BIBIANE NDUMGIEM
Entity type:Individual
Prefix:DR
First Name:BIBIANE
Middle Name:NDUMGIEM
Last Name:FOPPA
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 1:2943 HEWITT AVE APT 376
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3132
Mailing Address - Country:US
Mailing Address - Phone:443-537-7882
Mailing Address - Fax:
Practice Address - Street 1:2943 HEWITT AVE APT 376
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3132
Practice Address - Country:US
Practice Address - Phone:240-938-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist