MEDICARE: DR. ETONDE M MUSONGE TARKANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD035529	DC
2	207R00000X	Internal Medicine Physician	D0063390	MD

General Provider Information

NPI Number	:	1912070111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETONDE M MUSONGE TARKANG MD

Provider Business Mailing Address
First Line	:	2101 EAST JEFFERSON STREET
Second Line	:	PPQA MEDICARE COMPLIANCE UNIT 6 WEST
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-6660
Fax Number	:	301-816-6308

Provider Business Practice Location Address
First Line	:	110 IRVING STREET NW
Second Line	:	SUITE GB 10
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-2444
Fax Number	:	202-877-7069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/28/2013

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